Universität zu Köln

Stier, Christine ORCID: 0000-0002-7508-7775, Koschker, Ann-Cathrin, Kim, Mia, Stier, Raphael, Chiappetta, Sonja ORCID: 0000-0002-1964-416X and Stein, Juergen (2022). Fast-track rescue weight reduction therapy to achieve rapid technical operability for emergency bariatric surgery in patients with life-threatening inoperable severe obesity - A proof of concept study. Clin. Nutr. ESPEN, 50. S. 238 - 247. AMSTERDAM: ELSEVIER. ISSN 2405-4577

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Abstract

Background and aims: Severe obesity (BMI >= 60 kg/m(2)) in multimorbid patients can be acutely life-threatening. While emergency weight-loss surgery is urgently needed to preserve life, most patients are in an inoperable state. Pre-surgical bridging therapy is required to achieve technical operability through weight reduction. Standard bridging using an intragastric balloon (IB) can achieve operability in 6 months but is unsuitable for some patients in a critical condition. A non-invasive fast-track rescue therapy to achieve very rapid operability is urgently needed. We investigated whether a rescue weight reduction therapy (RWR) consisting of liraglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, a leucine-rich amino acid infusion and a hypocaloric diet, can accelerate readiness for emergency surgery in patients with acutely life-threatening severe obesity. Methods: In this proof-of-concept study, prospective data from patients treated with RWR (intervention group 1, n = 26) were mathematically matched with retrospective biometric data of 26 patients with severe obesity (historic control group 2) who underwent standard 6-month bridging with IB. A rating scale was developed to identify patients needing urgent fast-track bridging. Results: Rapid weight loss was observed in all patients on the RWR therapy. All achieved operability after a mean RWR bridging duration of 20.7 +/- 6.9 days. Baseline weight was 236.3 +/- 35.8 kg in group 1 compared with 230.1 +/- 32.7 kg in group 2. Mean body weight loss during RWR was 27.5 +/- 14.1 kg, compared with 20.9 +/- 10.5 kg in group 2 (P = 0.0629). Conclusions: Pre-operative bridging using liraglutide in combination with a leucine-rich amino acid infusion and hypocaloric diet was effective in all cases of acutely life-threatening severe obesity, achieving technical operability within only ca. 2-4 weeks. This therapy has potential as a life-saving rescue therapy for multimorbid patients with severe obesity who were previously untreatable. (C) 2022 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Stier, Christine UNSPECIFIED orcid.org/0000-0002-7508-7775 UNSPECIFIED Koschker, Ann-Cathrin UNSPECIFIED UNSPECIFIED UNSPECIFIED Kim, Mia UNSPECIFIED UNSPECIFIED UNSPECIFIED Stier, Raphael UNSPECIFIED UNSPECIFIED UNSPECIFIED Chiappetta, Sonja UNSPECIFIED orcid.org/0000-0002-1964-416X UNSPECIFIED Stein, Juergen UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-684052
DOI:	10.1016/j.clnesp.2022.05.009
Journal or Publication Title:	Clin. Nutr. ESPEN
Volume:	50
Page Range:	S. 238 - 247
Date:	2022
Publisher:	ELSEVIER
Place of Publication:	AMSTERDAM
ISSN:	2405-4577
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language AMINO-ACID SUPPLEMENTATION; FOOD-INTAKE; L-LEUCINE; LIRAGLUTIDE; PHYSIOLOGY; GLP-1; HYPOTHALAMUS; BALANCE; GLUCOSE; BIOLOGY Multiple languages Nutrition & Dietetics Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/68405