Obesity remains an epidemic associated with significant health consequences. Endoscopic sleeve gastroplasty (ESG) can lead to significant and sustained weight loss, with heterogeneous response. We previously reported a machine-learning (ML) assisted genetic risk score (GRS) for calories to satiation that predicts response to anti-obesity medications. Here, we evaluated the performance of novel GRSs for emotional hunger (EH), and calories to satiation (CTS, also high or low CTSGRS) to predict weight loss after ESG. Individuals treated with ESG at two separate endobariatric centers completed genetic testing using MyPhenome® test (Phenomix Sciences, Menlo Park, CA). This test uses a machine-learning (ML) assisted GRS for high or low CTSGRS and a GRS score combined with survey responses for EH. The primary outcome was total body weight loss (TBWL) after ESG at 12 and 24 months. Last observation carried forward (LOCF) analysis was used for missing values. Statistical analysis was performed using ANOVA analysis for multiple groups, and Tukey’s HSD for pairwise analysis. Forty individuals completed testing. The low CTSGRS group had a greater TBWL than both other groups at all observed time points (3 to 24 months). TBWL in the low CTSGRS group was most significant at 12 months using LOCF analysis (21.4

INTRODUCTION:Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) with lumen-apposing metal stents (LAMS) is an effective strategy for high-risk surgical patients. The optimal access route-transgastric (TG) versus transduodenal (TD)-remains uncertain. We compared outcomes of TG versus TD EUS-GBD at a high-volume tertiary center. METHODS:We included patients who underwent EUS-GBD between January 2020 and December 2024. Baseline demographics, clinical variables, and outcomes data were collected. The primary outcome was clinical success, defined as resolution of cholecystitis or relief of biliary obstruction. Secondary outcomes included stent misdeployment, adverse events (AEs), and need for endoscopic reintervention. Comparisons were performed using the unpaired T-test, Mann-Whitney U test, and Fisher's exact test, with significance at p < 0.05. RESULTS:We included 82 patients (mean age 72 years, 48% female). The indication for drainage was cholecystitis for 45 (55%) patients and MDBO with a patent cystic duct and prior failed ERCP for 37 (45%) patients. Sixty-four (78%) patients underwent transduodenal (TD) EUS-GBD and 18 (22%) underwent transgastric (TG) EUS-GBD. There was no difference between the two groups for clinical success (TD 89% vs. TG 94%, p = 0.68) overall nor when evaluated by procedural indication. There were five (8%) cases of stent misdeployment in the TD EUS-GBD group and zero cases in the TG EUS-GBD group (p = 0.58), all of which were salvaged endoscopically. There were no significant differences between groups for AEs (20% vs. 17%, p = > 0.99) or unplanned endoscopic reintervention (16% vs. 11%, p = > 0.99). CONCLUSIONS:Both TG and TD EUS-GBD are effective and relatively safe, supporting an individualized approach based on technical feasibility and future surgical candidacy. A potential trend toward more misdeployments in the TD EUS-GBD group warrants further study.

Roux-en-Y gastric bypass (RYGB) has long been established as one of the most efficient therapeutic options for patients with obesity and associated medical conditions. However, the impact of concurrent vagal transection during pouch creation on postoperative outcomes remains underreported. This retrospective cohort study examined patients who underwent RYGB between January 2011 and December 2023, with 1 to 5 years of follow-up. Patients were stratified into two groups: vagal sparing RYGB (VS) and non-vagal sparing RYGB (NVS). Data collected included postoperative complications, intraoperative characteristics, weight trajectories, resolution of obesity-related medical conditions, and mortality. Statistical analysis methods included paired t-tests, multivariate regression, and Cox regression models. Out of 1521 patients, 374 (24.6

Mayo Clinic Minnesota, USA; Waikato Hospital, New Zealand.

The American Gastroenterological Association (AGA) has long focused on health care disparities and is committed to achieving health equity through broad initiatives, such as the AGA Equity Project.1 Globally and in the United States, racial and ethnic minority groups are disproportionately burdened by digestive disease. Chronic liver disease, cirrhosis, and hepatocellular carcinoma are more prevalent in racial and ethnic minority groups.2–4 African American people have the highest incidence and mortality of colorectal cancer.