ASMBS 2011: Wrapping Up, Finishing Strong

asmbs 2011ASMBS has just come to a close after a week of education, discussion, and presentations. There were several excellent concurrent sessions on Thursday afternoon, including sessions on the sleeve gastrectomy and gastric plication.  The symposium on the rationale for surgical treatment of patients with class I obesity (BMI 30-35 kg/m2) was very well attended, and featured Dr. Jaime Ponce speaking on the adjustable gastric band, Dr. Jacques Himpens on sleeve gastrectomy, and Dr. Ninh Nguyen on the gastric bypass.  Dr. Stacy Brethauer from the Cleveland Clinic then presented a summary of the process and proposed content of an ASMBS Clinical Position Statement on BMI 30-35 kg/m2 patients.  He concluded that the highest level of scientific evidence (level 1) is currently available for gastric banding, but is not yet available for sleeve gastrectomy or gastric bypass.  He pointed out that several randomized clinical trials are underway to evaluate the safety and effectiveness of these other procedures in Class I obesity.

The late afternoon sessions covered topics on metabolic surgery, bariatric surgery in adolescent patients, and a symposium on highlights of published data from the National Institute of Health funded LABS consortium (Longitudinal Assessment of Bariatric Surgery).  Dr. Steven Belle, one of the principal investigators for the study and leader of the data coordinating center, described how LABS is different from most surgical studies due to the rigorous data definitions and data collection methods.  Dr. Emma Patterson and Dr. Alfons Pomp then reviewed some of the publications so far from LABS.  Some of the conclusions from this large prospective cohort are that bariatric surgery is safe (0.3% 30 day mortality), and that the gastric band is safer than the laparoscopic gastric bypass (1.0% complications versus 4.8%).  LABS investigators found that revisional bariatric surgery incurs twice the risk of serious complications compared with primary, or first-time weight loss surgery.  Patterson also reviewed the LABS publication in SOARD on the relationship between surgeon annual volume of gastric bypass procedures and adverse outcomes.  After adjusting for procedure (open versus laparoscopic) and patient risk factors, for each 10 cases per year, additional risk of adverse outcome decreased 10%.

ASMBS wrapped up with an emerging technologies event on Friday morning, where talks on new concepts, investigational devices, and late-breaking research were presented.  Dr. Jaime Ponce presented results of prospective randomized trial to evaluate the safety and efficacy on the intragastric dual balloon in obese subjects, that he conducted with co-investigators Dr. Brian Quebbemann and Dr. Emma Patterson.  The device appeared to be safe and induce some weight loss, and a plans for a pivotal trial leading to FDA approval are in progress. The press release can be read here.

Dr. Ariel Ortiz presented results of a pilot study of ten patients who received an intragastric balloon that has a unique delivery method: the patient swallows it.  The balloon is in a capsule that rapidly dissolves, and then the balloon is inflated with carbon dioxide via a very small catheter, as opposed to other stomach balloons which are usually placed via an endoscopic procedure.  The patients did lose some weight at the very short-term follow up of 30 days in this feasibility study.

The last two presentations of ASMBS were by Dr. Helmuth Billy and Dr. Emma Patterson on laparoscopic adjustable gastric banding with 2.7 mm micro laparoscopic ceramic-titanium reusable instruments.


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