American Society for Metabolic and Bariatric Surgery literature review on risk factors, screening recommendations, and prophylaxis for marginal ulcers after metabolic and bariatric surgery.

Background: Marginal ulcers (MU) are a significant postoperative complication following anastomotic metabolic and bariatric surgeries including Roux-en-Y gastric bypass (RYGB), one-anastomosis gastric bypass (OAGB), and biliopancreatic diversion with duodenal switch (BPD/DS). This review summarizes current knowledge on MU risk factors, screening, and prophylactic strategies.

Objectives: The goal of this review is to examine technical and patient-related risk factors for MU, assess screening strategies, and recommend prophylactic approaches to reduce MU incidence after anastomotic metabolic and bariatric surgery (MBS).

ASMBS literature review on the treatment of marginal ulcers after metabolic and bariatric surgery.

Marginal ulcers (MUs) encompass a group of mucosal disruptions and subsequent inflammatory changes and their sequala found after Roux-en-Y gastric bypass (RYGB) oneanastomosis gastric bypass (OAGB), and, less commonly, after biliopancreatic diversion with duodenal switch (BPD/DS) or single anastomosis duodeno-ileostomy with sleeve gastrectomy (SADI-S). Prevalence of MU after RYGB ranges from .6%-16%.

Development of an in vitro ventricular shunt material testing model and utility of PEG as antifouling coating.

Objective: CSF shunts, most commonly the ventriculoperitoneal shunt, remain a first and last line of management for children and adults with hydrocephalus. However, the failure rates of these shunts are extremely high, leaving many patients with the need for revision surgical procedures. The objective of this study was to develop a model to assess the efficacy of a nonfouling ventricular catheter.

A National Study on Training Innovation in US Medical Education.

Introduction Traditional medical education has leaned heavily on memorization, pattern recognition, and learned algorithmic thinking. Increasingly, however, creativity and innovation are becoming recognized as a valuable component of medical education. In this national survey of Association of American Medical Colleges (AAMC) member institutions, we seek to examine the current landscape of exposure to innovation-related training within the formal academic setting.

SARS-CoV-2 infection drives an inflammatory response in human adipose tissue through infection of adipocytes and macrophages.

Obesity, characterized by chronic low-grade inflammation of the adipose tissue, is associated with adverse coronavirus disease 2019 (COVID-19) outcomes, yet the underlying mechanism is unknown. To explore whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection of adipose tissue contributes to pathogenesis, we evaluated COVID-19 autopsy cases and deeply profiled the response of adipose tissue to SARS-CoV-2 infection in vitro. In COVID-19 autopsy cases, we identified SARS-CoV-2 RNA in adipocytes with an associated inflammatory infiltrate.

Pilot study of responsive nucleus accumbens deep brain stimulation for loss-of-control eating.

Cravings that precede loss of control (LOC) over food consumption present an opportunity for intervention in patients with the binge eating disorder (BED). In this pilot study, we used responsive deep brain stimulation (DBS) to record nucleus accumbens (NAc) electrophysiology during food cravings preceding LOC eating in two patients with BED and severe obesity (trial registration no. NCT03868670).

Literature review on antiobesity medication use for metabolic and bariatric surgery patients from the American Society for Metabolic and Bariatric Surgery Clinical Issues Committee.

The following literature search is in response to inquiries made to the American Society for Metabolic and Bariatric Surgery (ASMBS) regarding antiobesity medication (AOM) use in patients who are having or have already had metabolic and bariatric surgery (MBS). These recommendations are based on current clinical knowledge, expert opinion, and published peer-reviewed scientific evidence available at this time. This paper is not intended to establish a local, regional, or national standard of care.

Beyond 5 years: a matched cohort of sleeve gastrectomy versus gastric bypass.

Background: Laparoscopic sleeve gastrectomy (LSG) has demonstrated excellent short-term outcomes. However, existing studies suffer from loss to follow-up, and most long-term data focus on laparoscopic Roux-en-Y gastric bypass (LRYGB). This study compares weight loss in patients ≥5 years from LSG with that in matched patients who underwent LRYGB.

Can responsive deep brain stimulation be a cost-effective treatment for severe obesity?

Objective: A first-in-human responsive deep brain stimulation (rDBS) trial (NCT03868670) for obesity is under way, which is based on promising preclinical evidence. Given the upfront costs of rDBS, it is prudent to examine the success threshold for cost-effectiveness compared with laparoscopic Roux-en-Y gastric bypass (LRYGB).

Methods: Efficacy and safety data on LRYGB and safety data on rDBS were collected for established indications through a literature search.

Gastroesophageal Reflux Disease and the Patient with Obesity.

Patients with obesity who present with gastroesophageal reflux disease (GERD) require a nuanced approach. Those with lower body mass index (BMI) (less than 33) can be counseled on weight loss, and if successful may be approached with laparoscopic fundoplication. Those who are unable to achieve weight loss or those who present with a BMI greater than or equal to 35 should proceed with laparoscopic Roux-en-Y gastric bypass (LRYGB).

Situating Artificial Intelligence in Surgery: A Focus on Disease Severity.

Objectives: Artificial intelligence (AI) has numerous applications in surgical quality assurance. We assessed AI accuracy in evaluating the critical view of safety (CVS) and intraoperative events during laparoscopic cholecystectomy. We hypothesized that AI accuracy and intraoperative events are associated with disease severity.

Achalasia: physiology and diagnosis.

Achalasia is a rare motility disorder with incomplete relaxation of the lower esophageal sphincter and ineffective contractions of the esophageal body. It has been hypothesized that achalasia does not result from only one pathway but rather involves a combination of infectious, autoimmune, and familial etiological components. On the basis of other observations, a novel hypothesis suggests that a muscular form of eosinophilic esophagitis is involved in the pathophysiology of achalasia in some patients.

Brain-Responsive Neurostimulation for Loss of Control Eating: Early Feasibility Study.

Background: Loss of control (LOC) is a pervasive feature of binge eating, which contributes significantly to the growing epidemic of obesity; approximately 80 million US adults are obese. Brain-responsive neurostimulation guided by the delta band was previously found to block binge-eating behavior in mice. Following novel preclinical work and a human case study demonstrating an association between the delta band and reward anticipation, the US Food and Drug Administration approved an Investigational Device Exemption for a first-in-human study.

Innovation in hemodialysis: Using the Biodesign process to identify unmet needs.

There is renewed demand to accelerate innovation in nephrology; public and private sectors are creating programs to support its growth. The Stanford Biodesign innovation process, first developed in 2000, provides a roadmap for health technology and device innovation. There is insufficient published guidance on the application of the Biodesign process in the generation of novel devices to address nephrology- and/or dialysis-related clinical unmet needs.

Long-term outcomes of per-oral endoscopic myotomy compared to laparoscopic Heller myotomy for achalasia: a single-center experience.

Introduction: Many centers have reported excellent short-term efficacy of per-oral endoscopic myotomy (POEM) for the treatment of achalasia. However, long-term data are limited and there are few studies comparing the efficacy of POEM versus Heller Myotomy (HM).

Aims: To compare the long-term clinical efficacy of POEM versus HM.

Analysis of Gender Perceptions in Health Technology: A Call to Action.

Gender diversity has been linked to positive business results. Yet limited data exist to characterize the gender landscape in health technology, a field that draws employees from both biomedical engineering and medicine. To better understand the state of gender diversity in this industry, we developed a survey to explore leadership representation and perceptions of workplace equality, job satisfaction, and work-life balance.

Stanford's Biodesign Innovation program: Teaching opportunities for value-driven innovation in surgery.

The Stanford Biodesign Innovation process, which identifies meaningful clinical needs, develops solutions to meet those needs, and plans for subsequent implementation in clinical practice, is an effective training approach for new generations of healthcare innovators. Continued success of this process hinges on its evolution in response to changes in healthcare delivery and an ever-increasing demand for economically viable solutions. In this article, we provide perspective on opportunities for value-driven innovation in surgery and relate these to value-related teaching elements currently integrated in the Stanford Biodesign process.

Preoperative weight loss: is waiting longer before bariatric surgery more effective?

Background: Many insurance companies require patients to undergo supervised weight loss programs lasting several months. However, the association between time to surgery (TTS)-the wait time between the initial consultation visit and the immediate preoperative visit-and weight loss is not well documented.

Objectives: To investigate whether TTS affects pre- or postoperative weight loss or complication rates.

Novel device to detect enterotomies in real time during laparoscopy: first in human trial during Roux-en-y gastric bypass.

Background: Undetected bowel perforations occur in 0.3-1% of laparoscopic surgical procedures with an associated mortality rate of 5.3%.