EndoBarrier as a pre bariatric surgical intervention in high risk patients: a feasibility study

Introduction: Obesity surgery mortality risk scoring system (OS-MRS) classifies patients into high, intermediate and low risk; based on age, body mass index, sex and other co- morbidities such as hypertension and history of pulmonary embolism. High risk patients not only have a higher mortality, but are more likely to develop post-operative complications necessitating intervention or prolonged hospital stay following bariatric surgery. Endoscopically placed duodenal-jejunal bypass sleeve (EndoBarrier) has been designed to achieve weight loss and improve glycaemic control in morbidly obese patients with clinically proven effectiveness. The aim of this study was to assess if preoperative insertion of endobarrier in high risk patients can decrease morbidity and length of stay after bariatric surgery. Materials & Methods: In between 2012 and 2014, a cohort of 11 high risk patients had an EndoBarrier inserted (E&BS Group) for one year prior to definitive bariatric surgery. These patients were compared against a similar group undergoing primary bariatric surgery (PBS Group) during same duration. The two groups were matched for age, gender, body mass index, comorbities, surgical procedure and OS-MRS using propensity score matching. Outcome measures included operative time, morbidity, length of stay, ITU stay, readmission rate, percentage excess weight loss (%EWL) and percentage total weight loss (%TWL). Results: Patient characteristics and OS-MRS were similar in both Groups (match tolerance: 0.1). There was no significant difference in total length of stay, readmission rate, %EWL and %TWL. Operative time, ITU stay, post-operative complications and severity of complications were significantly less in E&BS Group (p<0.05) with significant likelihood of planned ITU admissions in PBS group (p<0.05). Conclusion: EndoBarrier could be considered as a pre-bariatric surgical intervention in high risk patients. It may result in improved postoperative outcomes in high risk bariatric patients.

Biography :

Hafsa Younus is a Surgical Trainee and is currently working as a Senior Researcher at King’s College Hospital London. She is an inquisitive Researcher with a special interest in new and novel techniques and innovative ideas to improve postoperative outcomes. She has published many papers in peer reviewed journals and is serving as a Reviewer of a reputed journal.

E-mail: hafsayounus@nhs.net

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