Becker's ASC Review

25 GASTROENTEROLOGY Could Endoscopic Sleeve Gastroplasty be an Alternative to Bariatric Surgery? By Eric Oliver A ccording to a report published in Clinical Gastroenterology and Hep- atology, endoscopic sleeve gastro- plasty could be a viable alternative to bariatric surgery for some obese patients. Here's what you should know. 1. ESG can delay gastric emptying, induce early satiation and reduce body weight. 2. Although bariatric surgery is the most effective surgical option, patients have limited access to it because of the surgery's risks and associated costs. 3. ESG uses a full-thickness endoscopic su- turing device to reduce the gastric reservoir. Patients require general anesthesia and occa- sionally an overnight observational stay. 4. In a clinical trial, 25 obese individuals un- derwent ESG with "endoluminal creation of a sleeve along the gastric lesser curve and were followed for a media period of nine months." 5. Researchers found that the subjects lost 53 percent ± 17 percent of excess body weight six months aer the procedure, and maintained a 45 percent ± 41 percent loss 20 months aer the procedure. 6. Patients did experience significant delays — up to 90 minutes — in gastric emptying, however. 7. e researchers concluded "for endoscopic bariatric therapy to have a meaningful effect on obesity, it should reach a threshold of effi- cacy that is balanced with risk and cost of the intervention." n Microbial Richness, Presence of Methanogens Negatively Associated With IBS By Jessica Kim Cohen A study in Gastroenterology sought to identify an intestinal microbiota profile associated with the severity of irritable bowel syndrome. The researchers identified 110 participants with IBS and 39 health participants, including 232 fecal samples and 59 mucosal biopsy samples. They investigated whether composition of the intestinal microbiota was associated with clini- cal features of IBS. Here's what you need to know: 1. The researchers leveraged a machine learn- ing procedure to identify a microbial signature for severe IBS, which encompassed 90 bacterial operational taxonomic units. 2. IBS symptom severity was negatively associated with microbial richness, exhaled CH4, presence of methanogens and enterotypes enriched with Clostridiales or Prevotella species. 3. In a validation set, the researchers were able to use the signature to differentiate between pa- tients with severe symptoms, patients with mild or moderate symptoms and healthy subjects. 4. This intestinal microbiota profile could not be explained by differences in diet or use of medi- cations, which suggests an independent asso- ciation with IBS symptoms. n 50% of Gastroenterologists Feel Burnout — 10 Takeaways By Eric Oliver M edscape compiled its "2017 Gastroenterolo- gist Lifestyle Report" survey finding that 50 percent of gastroenterologists report feel- ing burned out. Medscape surveyed more than 14,000 physicians from more than 27 specialties to create a snapshot of physician opinions on race, ethnicity, bias and phy- sician burnout. Here's what you should know. 1. Fifty percent of gastroenterol- ogists report feeling burned out. Overall, 40 percent of all physi- cians report feeling burned out. 2. On a scale of one to seven, gastroenterologists reported their burnout severity was 4.0, which is slightly below the 4.2 average. 3. The three leading causes of burnout among gastroenterolo- gists were "too many bureau- cratic tasks, spending too many hours at work and the increased computerization of practice." 4. Concerning gender, 54 per- cent of men report feeling burned out to 65 percent of women. 5. A majority — 58.1 percent — of gastroenterologists are white/ Caucasian, 13.2 percent are Asian Indian and 7.5 percent are Chinese or Hispanic/Latino. 6. Seventy percent of Chinese, 49 percent of white/Caucasian and 49 percent of Asian Indian gastroenterologists report being the most burned out. 7. Eleven percent of gastroenter- ologists report that bias affects their treatment. Gastroenterolo- gists had the eighth lowest re- ported bias rate among the 27 specialties. 8. On physician happiness, 64 percent of gastroenterologists report being happier outside of work than the 35 percent that are happiest while at work. 9. Concerning savings, 46 per- cent of men report having ad- equate savings to 51 percent of women. Twenty-six percent of women report having more than adequate savings compared to only 21 percent of men. 10. On debt, 57 percent of men report having manageable debt compared to 61 percent of women. n

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