Department of Surgery, University of Colorado School of Medicine, 12631 E 17Th Ave, C-305, Aurora, CO, 80045, USA.
Rocky Mountain Regional Veteran Affairs Medical Center, Aurora, CO, USA.
Surg Endosc. 2024 Oct;38(10):6070-6075. doi: 10.1007/s00464-024-11169-z. Epub 2024 Aug 13.
Over half of Americans and up to 78% of US Veteran population meet criteria for obesity. Perioperatively placed intragastric balloon (IGB) can accelerate weight loss goals for safe surgical candidacy, however weight regain is common after removal. Glucagon-like peptide-1-receptor agonists (GLP1RA) may provide a more sustainable weight loss solution after surgery. We hypothesize that weight regain will be less at 1 year after initiation of GLP1RA than IGB placement in Veterans.
Retrospective review of prospective databases of perioperatively placed intragastric balloon cohort from 1/2019-1/2023 compared to patients who received initiatory GLP1RA from 6/2021-8/2022 at a VA Medical Center(VAMC). All patients were enrolled in the VAMC MOVE! multidisciplinary weight management program for a minimum of 12 weeks. Outcomes measured were patients' weights at 0, 3, 6, and 12 months and weight change for these intervals. Exclusion criteria included history of bariatric surgery and incomplete weight loss data.
Two-hundred-twenty-three patients met inclusion criteria; 110 (49%) patients excluded. Mean age was 54 ± 11 years, the majority (78, 69%) were male, and the mean initial BMI was 37 ± 5.9 kg/m. Seventeen (15%) patients underwent IGB placement and 96 (85%) patients received semaglutide. Weight (kg) change was measured at intervals: 0-3 months:- 11.8(- 17,- 9.5) IGB vs. - 5.1(- 7.4,- 2.3) semaglutide, p < 0.0001; 0-6 months:- 12.7(- 18.4,- 9.9) vs. - 9.4(- 12.6,- 6.1), p = 0.03; 3-6 months:- 0.5(- 2.3,2.3) vs. - 4.3(- 6.8,- 1.6), p < 0.0001; 6-12 months:3(0,7.3) vs. - 1.9(- 4.7,1), p = 0.0006.
Weight loss occurs more rapidly in the first 6 months after intragastric balloon placement compared to semaglutide (- 12.7 vs. - 9.4 kg, p = 0.03). Despite ongoing attendance in a comprehensive weight loss program, weight regain is common after IGB removal by an average of 3 kg (23.6%) at 1 year. In contrast, patients on GLP1RA (semaglutide) continue to lose weight during this period. Further studies are needed to determine if optimal long-term outcomes may result from combination therapy with intragastric balloon and semaglutide.
超过一半的美国人和高达 78%的美国退伍军人符合肥胖标准。围手术期放置的胃内球囊（IGB）可以加速安全手术候选者的减肥目标，但在移除后体重会重新增加。胰高血糖素样肽-1 受体激动剂（GLP1RA）可能为手术后提供更可持续的减肥解决方案。我们假设 GLP1RA 治疗组的体重恢复会比 IGB 治疗组少。
回顾性分析 2019 年 1 月至 2023 年 1 月间围手术期放置胃内球囊队列的前瞻性数据库，与 2021 年 6 月至 2022 年 8 月间在退伍军人事务部医疗中心（VAMC）接受初始 GLP1RA 治疗的患者进行比较。所有患者都参加了 VAMC 的 MOVE！多学科体重管理计划至少 12 周。测量的结果是患者在 0、3、6 和 12 个月时的体重和这些时间段的体重变化。排除标准包括减肥手术史和不完整的减肥数据。
223 名患者符合纳入标准，其中 110 名（49%）患者被排除。平均年龄为 54±11 岁，大多数（78 名，69%）为男性，平均初始 BMI 为 37±5.9kg/m。17 名（15%）患者接受了 IGB 治疗，96 名（85%）患者接受了司美格鲁肽治疗。体重（kg）变化在不同时间点测量：0-3 个月：-11.8（-17，-9.5）IGB 与-5.1（-7.4，-2.3）司美格鲁肽，p<0.0001；0-6 个月：-12.7（-18.4，-9.9）与-9.4（-12.6，-6.1），p=0.03；3-6 个月：-0.5（-2.3，2.3）与-4.3（-6.8，-1.6），p<0.0001；6-12 个月：3（0，7.3）与-1.9（-4.7，1），p=0.0006。
与司美格鲁肽（-12.7 比-9.4kg，p=0.03）相比，胃内球囊放置后前 6 个月体重下降更快。尽管持续参加全面的减肥计划，但在 IGB 移除后平均体重会重新增加 3kg（23.6%），1 年后体重恢复。相比之下，接受 GLP1RA（司美格鲁肽）治疗的患者在此期间继续减肥。需要进一步的研究来确定胃内球囊和司美格鲁肽联合治疗是否会带来更好的长期效果。
