Preoperative multidisciplinary team assessment (MTA) for bariatric surgery is complex and associated with high attrition rates. Digital health applications may improve patient engagement and completion rates, but evidence remains limited. In this prospective randomized controlled trial conducted at a tertiary bariatric center, patients aged ≥ 18 years with obesity II with obesity related medical problems or obesity III were randomized 1:1 to receive either standard multidisciplinary care alone (control group) or standard care plus a smartphone application (app group). The app provided digital checklists, appointment reminders, and automated alerts to healthcare providers for missed appointments. The primary outcome was successful completion of MTA, defined as being scheduled for metabolic and bariatric surgery or achieving sufficient weight loss, assessed at 18 months. Among 223 enrolled participants, 178 (79.8

Introduction:Dumping syndrome (DS) is a frequent complication after Roux-en-Y gastric bypass (RYGB), causing gastrointestinal and neurohumoral symptoms that can significantly affect quality of life. Transoral outlet reduction (TORe) has been used in clinical practice as a therapy of DS alongside other conservative and surgical approaches. Effectiveness of different therapy options remains unclear. This meta-analysis aimed to provide an overview of the available data concerning TORe. Methods:A meta-analysis was conducted, including ten retrospective studies identified through a literature search in five databases. All studies analyzed the resolution of DS symptoms after TORe through evaluation of the Sigstad score. Results:The literature search yielded 1,014 publications, of which ten retrospective studies involving a total of 320 patients met the inclusion criteria for this meta-analysis. The analysis showed that TORe led to a pooled success rate, defined as overall improvement of symptoms based on subjective patient responses or reduction of Sigstad score to <7 points of 95.59%, significant weight loss (p < 0.001), and an average reduction of Sigstad score by 8.71 points, indicating a consistent improvement in the severity of DS (p < 0.001). Conclusion:This meta-analysis demonstrates that TORe can be an effective, endoluminal treatment option for DS following RYGB. However, limitations include the retrospective nature of the studies, lack of long-term follow-up, and inconsistent outcome measures. No distinction between early and late DS was observed in any of the included trials. Future research should focus on prospective trials, standardized outcomes, and comparisons with surgical options in order to fully assess the efficacy and durability of TORe. The use of additional objective primary outcome measures, such as oral glucose tolerance testing and continuous glucose monitoring, is suggested.

BACKGROUND:Compliance with postoperative follow-up, physical activity, and nutrition is a known problem in patients receiving metabolic-bariatric surgery (MBS). This issue needs to be tackled not only through intervention studies. Patients' personal preferences and concerns need to be the center of a successful improvement of pre-and postoperative care in MBS. METHODS:A total of 323 participants from support groups all over the country were interviewed via an online survey concerning physical activity, use of media and health-related phone applications, and eating behavior. In addition, 14 open patient interviews were pursued before or after MBS regarding physical activity, eating behavior, and media use. RESULTS:Of subjects, 64.7% preferred small training groups of 6-10 people. The most popular types of sports were aqua sports, followed by walking and bicycle sports. One-third of the participants stated not enjoying the gym at all. In the open patient interviews, the main reason for this was fear of stigmatization. Sixty-three percent of patients stated a willingness to participate in a sports program designed specifically for MBS patients. CONCLUSIONS:Overall willingness towards an increase in physical activity after MBS is present. However, stigma and pain during sports or the inability to perform certain sports seem to be the main issue keeping patients away from physical activity. We suggest clinical trials towards training protocols in small groups of 6-10 people, aqua, walking, or biking sports, and specialized training protocols for MBS patients.

Cardiovascular disease and obesity-related comorbidities are key factors addressed by metabolic-bariatric surgery (MBS). Although High intensity interval training (HIIT) has been proven effective in healthy cohorts, limited evidence exists regarding HIIT and adherence towards HIIT after MBS. This study aims to test feasibility and cardiorespiratory effect of HIIT after MBS. 201 patients undergoing MBS were included in a four-week training protocol with 3 training groups (B-D) including different HIIT protocols on a bicycle designed for patients with obesity and one control group (A) at a university medical center in Germany. Ergometry with estimated VO2max, maximum blood lactate, maximum resistance, time spent on ergometer, and heart rate were performed prior to and after 4 weeks of training. A significant effect of the four-week training could be shown through reduction of heart rate at 100 W, increase of maximum blood lactate, and maximum resistance when comparing the training groups to the control group (Δ 9,67 BPM; Δ 1.02 mmol/l; Δ 12 W respectively, all p < 0.05) However, adherence of the recruited patient group was very low, shown by a notably high drop-out rate of 78.1

Background: Bariatric surgeries, specifically laparoscopic sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), are a common intervention for morbid obesity, significantly affecting food tolerance and quality of eating. Understanding these changes is crucial for improving postoperative care and long-term success. Methods: This observational study at University Hospital Mannheim involved 91 patients, aged between 18 and 65 year, who underwent SG or RYGB between 2009 and 2019. Food tolerance was assessed between 25 days and 117 months after surgery using the validated score by Suter et al. (Food Tolerance Score, FTS) and an additional score evaluating tolerance to specific food groups and quality of life. Data on body composition were collected through Bioelectrical Impedance Analysis (BIA) at follow-up visits. Statistical analyses included linear mixed models to analyze the association of food tolerance with body composition changes. Results: The FTS indicated moderate or poor food tolerance in 62.6% of patients, with no significant differences between SG and RYGB. Considering the results of the additional score, food groups such as red meat, wheat products, raw vegetables, carbon dioxide, fatty foods, convenience food, and sweets were the most poorly tolerated food groups. A total of 57 of the participants had a baseline and follow-up BIA measurement. Postoperatively, a significant reduction in body weight and BMI as well as in BIA parameters (fat mass, lean mass, body cell mass, and phase angle) was found. Quality of life improved after bariatric surgery and 76.9% rated their nutritional status as good or excellent, despite possible food intolerances. Conclusions: Bariatric surgery significantly reduces weight and alters food tolerance. Despite moderate or poor food tolerance, patients reported high satisfaction with their nutritional status and quality of life. Detailed food tolerance assessments and personalized dietary follow-ups are essential for the early detection and management of postoperative malnutrition, ensuring sustained weight loss and improved health outcomes.

Background: Bariatric surgery (BS) currently is the most effective treatment for severe obesity. To our knowledge, no data comparing different bariatric procedures regarding differences in gastrointestinal symptoms have been published.Methods: For this multicenter, prospective, nonrandomized clinical trial in Germany, 310 patients underwent screening, and 124 patients completed the study. Patients completed the following standardized questionnaires preoperatively and at 6 and 12 months after surgery: Gastrointestinal quality of life index, bowel disease questionnaire, and Cleveland clinic incontinence score.Results: Mean patient age was 44.4 years. Mean body mass index prior to surgery was 45.1 kg/m2. Physical function improved significantly after surgery (31.9 vs. 62.1 and 62.3, respectively, p < 0.001). Nausea and diarrhea symptoms worsened 12 months after sleeve gastrectomy (SG; p = 0.025 and p = 0.017, respectively). Constipation improved 12 months after SG (p = 0.006). Multivariate analysis revealed SG as an independent predictive factor for diarrhea (p = 0.026). Physical and emotional function improved for Roux-en-Y gastric bypass and SG.Conclusion: This study highlights differences in symptom outcomes after different bariatric procedures. Significant changes in bowel habits were seen especially after SG. Overall, BS improves quality of life. Side effects of surgery should not be a contraindication for surgery. However, patients can be educated regarding possible side effects, and the surgical procedure can be chosen individually.

Gastroesophageal reflux disease (GERD), often associated with obesity, impairs quality of life and can lead to complications. This study compared Fundoplication and Roux-en-Y Gastric Bypass (RYGB) in patients with WHO (World Health Organization) class I and II obesity and refractory GERD. A single-center, retrospective study analyzed 93 patients (55 Fundoplication, 38 RYGB) with BMI < 40 kg/m2 who underwent surgery between January 2018 and September 2021. Preoperative characteristics, surgical outcomes, and postoperative results after three months and after one year were analyzed. Quality of life was assessed using Bariatric Quality of Life (BQL) and Quality of Life in Reflux and Dispepsia (QOLRAD) questionnaires. Propensity-score matching (PSM) was performed using the parameters age, BMI and gender. Patients who underwent RYGB had higher preoperative BMI (35.9 vs. 27.5 kg/m2, p < 0.0001) and more metabolic comorbidities. Patients who underwent Fundoplication experienced longer anesthesia (192.5 vs. 112 min, p < 0.0001), operation times (134 vs. 79 min, p < 0.0001), and hospital stays (4 vs. 3 days, p = 0.0003). Complication rates in general (p = 0.0154, after three months) and dysphagia rates in particular (p = 0.0036, after three months and p = 0.0147, after one year) were higher in the Fundoplication group. Preoperatively, patients undergoing RYGB reported poorer quality of life in BQL questionnaires (p = 0.0008). PSM showed less reflux regression in the Fundoplication group after three months (p = 0.0223). Despite higher preoperative BMI and comorbidities, patients undergoing RYGB had shorter operative times and hospital stays. The results suggest RYGB may be preferable for patients with refractory GERD and class I and II obesity, but further research on long-term outcomes is needed.

Large language models (LLMs) can generate human-like, empathetic responses within seconds. Their potential in terms of comprehensibility, empathy, and completeness to support physician–patient communication in bariatric surgery care needs to be evaluated. We collected 200 real-world questions from patient support groups, initial consultations, and follow-up visits, which were answered by GPT-4o and two human bariatric experts. An independent bariatric expert then blindly evaluated the responses for their overall quality, accuracy, and comprehensiveness. If needed, the responses were corrected, and the correction time was documented. Afterwards, bariatric patients (n = 189) across Germany rated the responses, assessing each one on its clarity, empathy, and completeness. The LLM required significantly less time (2.7 vs. 87.2 s, p < 0.0001) and generated longer responses (607 vs. 262 characters, p = 0.001) than human experts. LLM-generated responses were rated significantly higher by patients in terms of clarity (4.8 vs. 4.6), completeness (4.5 vs. 3.4), and empathy (4.1 vs. 3.2, all p < 0.0001). In total, 64.9

Abstract Background Patients receiving oncological esophagectomy or gastrectomy are known to be at high risk for vitamin and micronutrient deficiency before, during and after surgery. However, there are no clear guidelines for these cancer patients regarding postoperative vitamin supplementation. preoperative malnutrition has been shown to be associated with a higher risk of perioperative complications. In addition, malnutrition has shown to be an independent risk factor for reduced survival in cancer patients and early cancer recurrence. Methods This meta-analysis examines the prevalence of postoperative malnutrition, vitamin, and micronutrient deficiencies in patients who underwent gastrectomy or esophagectomy. A computer-based literature search was performed in several different databases with the The following search terms were used: vitamin, nutrition, deficienc*, malnutrition, osteoporos*, sarcopenia, esophagectom*, oesophagectom*, gastrectomy*, gastric, surg*, resect*, operat*, removal, excision, neoplas*, tumor, tumour, cancer, malign*adenocarcinom* squamous cell carcinom*. Out of 1611 studies, 42 documented relevant information, but only 17 provided 95% confidence intervals. After excluding seven studies due to insufficient data, the meta-analysis included 947 patients from 10 studies. Results The studies recorded vitamin and micronutrient blood levels from 3 months to 10 years post-surgery. The analysis found significant deficiencies in 25-OH Vitamin D3, Vitamin B12, and Serum Calcium levels. Patients had significantly lower Vitamin D3 levels compared to the healthy population, with mean levels in the lower normal range or lower. Serum Calcium levels were also significantly lower than the mean levels of the healthy population but stayed within the normal range. Mean Serum B12 levels were significantly lower than mean B12 levels in the standard population, but standard deviations stayed within the normal range. Serum albumin levels showed no signs of deficiency when compared to the healthy population. Similarly, no deficiency was detected in serum ferritin levels. Other vitamins and micronutrients studies included serum phosphorous, Vitamin A and Vitamin E, but data was insufficient for metanalysis. Discussion The study underscores the need for further research and guidelines to address postoperative nutritional deficiencies in these patients. Particularly, patients often develop a deficiency in Vitamin D3 after surgery, despite supplementation. Vitamin D3 insufficiency may increase perioperative risk and is concerning given the reduced calcium levels and bone marrow density. In conclusion there is a clear need for Vitamin D3 supplementation, both postoperatively and during the perioperative period. The study supports previous data indicating a high prevalence of postoperative micronutrient deficiency in esophagectomy patients. Given the high risk of malnutrition, screening should be a routine part of follow-up care. More data, particularly regarding deficiencies and supplementation after esophagectomy, is necessary.

Background & aimsPatients receiving oncological esophagectomy or gastrectomy are known to be at high risk for vitamin and micronutrient deficiency before, during and after surgery. However, there are no clear guidelines for these cancer patients regarding postoperative vitamin supplementation.MethodsWe conducted a metanalysis consisting of 10 studies regarding vitamin and micronutrient deficiencies after oncological gastric or esophageal resection. 5 databases were searched.ResultsData was sufficient regarding Vitamins B12 and 25-OH D3 as well as calcium. We were able to show deficiencies in 25-OH Vitamin D3 levels (p < 0.001) and lower levels of Vitamin B12 and calcium (bit p < 0.001) when compared to the healthy population.ConclusionsPatients from these groups are at risk for vitamin deficiencies. A guideline on postoperative supplementation is needed.

BACKGROUND AND AIMS:Boerhaave syndrome, an effort rupture of the esophagus, is a rare but serious condition. Endoscopic vacuum therapy (EVT) is a new therapeutic approach for GI perforation. We aimed to evaluate EVT for treatment of Boerhaave syndrome. METHODS:This retrospective study was conducted at 5 tertiary hospitals in southern Germany. All patients treated for Boerhaave syndrome since 2010 were identified and included. Treatment success and outcomes were assessed and compared between the different modes of primary treatment. RESULTS:Fifty-seven patients with Boerhaave syndrome were identified (median age, 68 years; n = 16 female). The primary treatment was EVT in 25 cases, surgery in 14, and endoscopic stenting in 15. Primary EVT was successful in 20 (80.0%) of the 25 patients. Two patients were switched to surgical treatment, 1 was switched to esophageal stenting, and 2 patients died. The mortality rate was lower (P = .160) in patients treated primarily with EVT (n = 2 [8.0%]) compared with patients in the non-EVT group (n = 8 [25.0%]). Treatment success was significantly higher (P = .007) for primary EVT (80.0%) than for non-EVT (43.8%). Primary EVT was associated with treatment success in multivariable analysis. CONCLUSIONS:EVT showed a high success rate for treatment of Boerhaave syndrome and was associated with treatment success.

Introduction Adherence to follow-up (FU) care after bariatric surgery is poor despite strong recommendations. In our pilot Bella trial, we demonstrated that a completely remote follow-up program via smartphone is feasible and safe for patients after bariatric surgery. Building on this, we aim to verify our results in a multicenter, randomized controlled setting. Methods This trial plans to enroll 410 participants undergoing primary bariatric surgery in seven German bariatric centers. Participants are randomized into two groups: a control group receiving in-person FU according to the standard in the bariatric centers, and an interventional group monitored using a smartphone application (app). The app sends standardized questionnaires and reminders regarding regular vitamin intake and exercises. The built-in messaging function enables patients to communicate remotely with medical care professionals. After one year, all participants are evaluated at their primary bariatric centers. The primary outcome is weight loss 12 months after surgery. The secondary outcomes include obesity-related comorbidities, quality of life, serum values of vitamins and minerals, body impedance analysis, visits to the emergency department or readmission, patient compliance, and medical staff workload. Discussion The current study is the first prospective, individually randomized-controlled, multicenter trial where a mobile application completely replaces traditional in-person visits for post-bariatric surgery follow-ups in bariatric centers.

Aims Boerhaave's syndrome is an effort rupture of the esophagus typically caused by heavy vomiting. Mortality without treatment is as high as 90% and even in patients treated with surgery mortality rate is approximately 20%. Endoscopic negative pressure therapy (ENPT) or endoscopic vacuum therapy is successfully used to treat anastomotic leakage after esophageal surgery. Goal of this study was to evaluate ENPT for treatment of Boerhaave's syndrome.

ZusammenfassungAdipositas ist eine globale Epidemie mit zunehmender Prävalenz, die einen interdisziplinären Ansatz für eine effektive Langzeitbehandlung erfordert. Trotz der Verfügbarkeit neuer medikamentöser Therapien bleibt die Anzahl der Patient*innen, die in Deutschland eine angemessene Behandlung erhalten, unzureichend. Das Disease Management Programm (DMP) für Adipositas, das im November 2023 eingeführt wurde, zielt darauf ab, die medizinische Versorgung zu verbessern, derzeit gibt es jedoch keine Kostendeckung für medikamentöse Therapie, postoperative Betreuung und umfassende Ernährungs- und Bewegungstherapien. Die Behandlung von Adipositas erfordert einen vielschichtigen Ansatz. Lebensstilinterventionen wie Ernährungsumstellungen und Bewegung sind wesentlich, aber oft nicht ausreichend für einen signifikanten Gewichtsverlust. Pharmakologische Behandlungen, insbesondere GLP-1-Agonisten, haben vielversprechende Ergebnisse gezeigt. Diese können jedoch aufgrund der fehlenden Kostenübernahme nur eingeschränkt eingesetzt werden. Die bariatrische Chirurgie bleibt die effektivste Langzeitbehandlung mit einem durchschnittlichen Gewichtsverlust von 30–40%. Sie wird für Patient*innen mit einem BMI über 40 kg/m² oder über 35 kg/m² mit Begleiterkrankungen empfohlen. Die Integration von chirurgischen und konservativen Therapien ist entscheidend für optimale Ergebnisse.