With the swift evolution of bariatric and metabolic surgery, additional procedures building upon sleeve gastrectomy have consistently surfaced. Recent studies suggest that sleeve gastrectomy with jejunojejunal bypass (SG-JJB) yields superior short-term weight reduction outcomes compared to sleeve gastrectomy alone, with weight loss and glycemic control effects akin to Roux-en-Y gastric bypass, and without significant complications. As a result, SG-JJB is regarded as a safe and efficacious bariatric procedure, noted for its technical simplicity and reversibility, presenting substantial clinical utility. Nonetheless, high-quality, multicenter, large-sample, long-term follow-up randomized controlled trials are essential to further ascertain its long-term efficacy and safety, and to facilitate its standardized implementation. This article seeks to review the advancements in SG-JJB research, evaluate its effectiveness and safety in managing obesity and associated comorbidities, and explore its future developmental trajectory.
Endoscopic bariatric treatment (EBT) is an effective method for the treatment of obesity. The principle of weight loss is similar to metabolic bariatric surgery. It can be classified as a food restriction (stomach-targeted) and malabsorption (small intestine-targeted). At present, a lot of EBT devices had been cleared by the US Food and Drug Administration to treat obesity, while the EBT in China lagged behind Western countries. Hence, we reviewed the current stomach-targeted EBT, aiming to provide a reference for the supplement of obesity treatment methods and the development of EBT in China.
Both bariatric surgery and pharmacotherapy, particularly glucagon-like peptide-1 receptor agonist (GLP-1RA), are effective interventions for obesity, yet each has its own advantages and limitations. Drawing on the “bridging” concept from cancer therapy, this commentary explores an innovative obesity management strategy that involves the combined application of GLP-1RA and bariatric surgery during the perioperative period, with the aim of optimizing treatment outcomes. The present analysis focuses specifically on the potential value of this approach: preoperatively, GLP-1RAs serve as a “bridging therapy” to promote weight loss and reduce surgical risks in severely obese patients; postoperatively, they might be used to manage weight rebound or insufficient weight loss. This multimodal integrated strategy is designed to overcome the inherent limitations of single therapies and offer patients more comprehensive treatment options. Emphasizing that future research must urgently focus on optimizing treatment parameters (e.g., timing, dosage), evaluating long-term safety and efficacy, and establishing patient selection criteria for combination therapy. Integrating surgical and pharmacological treatments, this comprehensive strategy based on the oncological “bridging” concept represents a highly promising paradigm shift in obesity management.
ObjectiveTo systematically review the efficacy and safety of laparoscopic Roux-en-Y gastric bypass (LRYGB) versus laparoscopic sleeve gastrectomy (LSG) for obesity and type 2 diabetes mellitus (T2DM).
MethodsWe searched PubMed, EMbase, The Cochrane Library (Issue 8, 2014), CNKI and WanFang Data from inception to December 2014, to collect randomized controlled trials (RCTs) of LRYGB vs. LSG for obesity and T2DM. Two reviewers independently screened literature, extracted data and evaluated the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software.
ResultsA total of 8 RCTs including 828 patients were included. The results of meta-analysis showed that:There were no significant differences between the LRYGB group and the LSG group in body mass index (MD=-1.02, 95%CI -2.90 to 0.86, P=0.29), remission rate of T2DM (OR=1.11, 95%CI 0.71 to 1.73, P=0.64), reoperation rate (OR=2.74, 95%CI 1.01 to 7.42, P=0.05), level of fasting plasma glucose (MD=2.71, 95%CI -0.80 to 6.21, P=0.13), and level of serum low density lipoprotein (MD=-23.85, 95%CI -47.20 to -0.50, P=0.05). However, the LSG group had lower postoperative complication rate (OR=2.28, 95%CI 1.43 to 3.62, P=0.000 5) than that of the LRYGB group.
ConclusionIn short term, both LRYGB and LSG were equally efficient in the treatment of obesity and T2DM, but LSG has lower postoperative complication rate than LRYGB. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
Objective
To review recent advancement of the relationship between obesity and gastric cancer.
Method
We searched PubMed, Medline, EMBASE, Cochrane Library databases, CNKI, and WanFang database for recent clinical trials about the impact of obesity on occurrence, surgery outcomes, and prognosis of gastric cancer.
Results
Obesity significantly increased the risk of adenocarcinoma of esophagogastric junction (AEG), increased difficulty in radical operation of gastric cancer and complications of perioperative period, but it had no effect on the long-term operative outcomes. The association between obesity and the survival of gastric cancer was not clear. However, the better survival was observed in most researches of gastric cancer patients with excess body weight.
Conclusions
The relationship between obesity and gastric cancer is very complex, and there is no consistent conclusion. A reasonable body weight by a healthy lifestyle is expected to decline the incidence of AEG.
ObjectiveTo investigate the effect of the remnant stomach after gastric bypass (GB) surgery on the weight loss and glucose metabolism in rats with obese and type 2 diabetes mellitus (T2DM).MethodsHigh fat feeding for one month combined with intraperitoneal injection of low-dose streptozotocin was used to induce obese rats with T2DM. Twenty-four rats with obese and type T2DM successfully established were randomly divided into resectional gastric bypass (R-GB) group, GB surgery (GB group), and sham operation (SO) group, eight rats in each group. The weight loss and anti-diabetic effect of the R-GB and GB were compared. Body weight, food intake, and fasting blood glucose (FBG) were measured at week 1 before operation and week 1–8 after the operation. Oral glucose tolerance test (OGTT) and insulin tolerance test (ITT) were performed using tail venous blood at week 1 before operation and on week 8 after operation (at 0, 30, 60, 90, and 120 min). The levels of serum glucagon like peptide-1 (GLP-1), gastrin, insulin, and glucagon at week 1 before operation and at week 8 after operation were detected, meanwhile the homeostasis model assessment insulin resistance (HOMA-IR) index was calculated.Results① The body weight and food intake of the rats in the R-GB group and GB group were lower than those in the SO group after operation (P<0.05) and which were lower than before operation (P<0.05), but the differences were not significant between the R-GB group and GB group after operation (P>0.05). ② The levels of FBG in the R-GB group only at week 1–4 after operation were lower than those before operation (P<0.05), while which in the GB group at week 1–8 after operation were lower than those before operation and were lower than in the SO group (P<0.05), but which in the R-GB group only at week 2–4 after operation were lower than in the SO group and which were higher than that in the GB group from 3 to 8 weeks after operation (P<0.05). ③ The area under receiver operating characteristic curves (AUCs) of blood glucoses of OGTT and ITT and HOMA-IR index at week 8 after operation were lower than those before operation (P<0.05) in the GB group and which were lower than those the other two groups (P<0.05). ④ The AUC of gastrin level at week 8 after operation was lower than that before operation in the R-GB group and which lower than that in the other two groups (P<0.05). The AUC values of insulin and glucagon levels at week 8 after operation were lower than those before operation in the GB group and which lower than those in the other two groups (P<0.05). The AUC of GLP-1 level at week 8 after operation was higher than that before operation in the GB group and which higher than that in the other two groups (P<0.05).ConclusionsGB could remarkably improve glucose metabolism and weight loss in obese rat with T2DM. Gastric remnant gastrectomy following GB has a remarkable anti-diabetic effect, but it doesn’t effect on weight loss.
Objective To systematically review the relationship between obesity and the incidence of digestive system cancers. Methods The PubMed, EMbase, The Cochrane Library, CNKI and WanFang Data databases were electronically searched to collect cohort studies on the relationship between obesity and digestive system cancers from January 1st, 2001 to October 31st, 2021. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.4 software. Results A total of 16 cohort studies were included. The results of meta-analysis revealed that compared with normal weight, obesity increased the incidence rate of various cancers of the digestive system, including colorectal cancer (RR=1.25, 95% CI 1.13 to 1.39, P<0.000 1), liver cancer (RR=1.65, 95%CI 1.41 to 1.92, P<0.000 01), pancreatic cancer (RR=1.34, 95%CI 1.19 to 1.51, P<0.000 01), gastric cancer (RR=1.09, 95%CI 1.05 to 1.14, P<0.000 1), and esophageal cancer (RR=2.39, 95%CI 1.98 to 2.89, P<0.000 01). Conclusion The current evidence indicates that obesity can increase the incidence rate of digestive system cancers. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.
ObjectiveTo systematically review the efficacy of auricular pressure therapy for simple obesity in adult.
MethodsWe electronically searched databases including The Cochrane Library (Issue 4, 2015), PubMed, Web of Science, MEDⅡNE (Ovid), CNKI, VIP, CBM and WanFang Data databases to collect randomized controlled trials (RCTs) of auricular pressure therapy for simple obesity from inception to March 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software.
ResultsA total of 17 RCTs involving 1 246 patients were included. The results of meta-analysis showed that:(1) Compared with the blank control group, the auricular pressure therapy group was superior in weight reduction (MD=-2.50, 95%CI -3.53 to -1.47, P<0.01), BMI reduction (MD=-1.50, 95%CI -2.52 to -0.48, P=0.004), and waist circumference reduction (MD=-3.20, 95%CI -4.38 to -2.02, P<0.01); (2) Compared with the placebo control group, the auricular pressure therapy group was superior in weight reduction (MD=-1.39, 95%CI -1.46 to -1.31, P<0.01), BMI reduction (MD=-0.65, 95%CI -0.91 to -0.38, P<0.01), body fat percentage reduction (MD=-0.58, 95%CI -0.67 to -0.49, P<0.01), and waist circumference reduction (MD=-2.34, 95%CI -4.23 to -0.46, P=0.01); (3) There were no significant differences between the auricular pressure therapy group and the body acupuncture group in weight reduction, BMI reduction, and waist circumference reduction (all P values >0.05); (4) Compared with the body acupuncture group, the auricular pressure combined with body acupuncture group was superior in BMI reduction (MD=-1.67, 95%CI -2.48 to -0.85, P<0.01); (5) Three RCTs reported adverse reactions including cyanotic skin, erythema near auricular pressure etc., and all adverse reactions were mostly mild and recovered after treatment.
ConclusionCurrent evidence indicates that auricular pressure therapy for simple obesity is superior to placebo and blank control, but similar to body acupuncture; the auricular pressure combined with body acupuncture is superior to body acupuncture alone in BMI reduction. Due to the limited quantity and quality of included studies, more high quality studies are needed to verify the above conclusion.
