Alfredo Genco

• Sapienza University of Rome

Weight regain (WR) after bariatric surgery, particularly sleeve gastrectomy, is a significant challenge, often driven by a combination of metabolic, behavioral, and lifestyle factors. Non-surgical interventions to manage WR are critical, given the increased risks and reduced efficacy of revisional surgeries. In this context, very low-calorie ketoge...

(1) Background: There is still disagreement over how sleeve gastrectomy (SG) affects gastroesophageal reflux disease (GERD). The debate regarding the best option for patients undergoing bariatric surgery who are also affected by GERD and/or hiatal hernia continues to divide the community of bariatric surgeons. While concomitant hiatal hernia repair...

Esophageal lesions ranging from erosive esophagitis to Barrett's esophagus (BE) eventually develop months-years after sleeve gastrectomy (SG), representing a significant post-surgical issue in GI practice. Roux-en-Y gastric bypass (RYGB) conversion is a widespread and effective method of managing reflux and esophageal complications following SG. Al...

Obesity is a major health burden and its prevalence is rapidly increasing. Endoscopic treatments may help patients with obesity to interrupt or slow down the weight gain, thereby reducing complications associated with excess weight. In patients with morbid obesity, the weight loss obtained with endoscopic procedures represents a chance to reduce th...

Introduction The Very Low-Calorie Ketogenic Diet (VLCKD) has emerged as a safe and effective intervention for the management of metabolic disease. Studies examining weight loss predictors are scarce and none has investigated such factors upon VLCKD treatment. Among the molecules involved in energy homeostasis and, more specifically, in metabolic ch...

Laparoscopic sleeve gastrectomy (SG) has reached wide popularity during the last 15 years, owing to limited morbidity and mortality rates, very successful weight loss results, and impact on comorbidities. However, the postoperative development or worsening of gastroesophageal reflux disease (GERD) is one of the most important drawbacks of this surg...

Purpose: Angiogenic markers in neuroendocrine neoplasms (NENs) have recently received increasing attention, but their clinical role remains unclear. The aim of this study was to evaluate the role of angiogenic markers in NEN aggressiveness and prognosis. Methods: We performed a prospective observational study including 46 consecutive patients wi...

Background Bariatric surgery has been shown to be the most effective treatment in achieving and maintaining weight loss and reducing obesity-related morbidities. Adequate measurement and control of pain allows for better postoperative outcomes and substantial reduction of complications, especially in subjects with morbid obesity. The aim of this st...

Introduction Gastro-oesophageal reflux disease (GORD) after bariatric surgery is a debated topic. This study investigated the prevalence of GORD and associated oesophageal complications following bariatric procedures—namely, adjustable gastric banding (AGB), sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one-anastomosis gastric bypas...

Background Sleeve gastrectomy (SG) leads to esophageal mucosal damage in an elevated percentage of cases, configuring a clinical condition of Barrett’s esophagus (BE) in a proportion as high as 15-18.8%. BE may finally, but seldom result in esophageal adenocarcinoma (EAC). Objective In consideration of the fact that BE is indeed a precancerous les...

Objective: To date, two questionnaires investigating the symptoms of gastroesophageal reflux disease (GERD) (Quality of Life Reflux and Dyspepsia and Reflux Disease Questionnaire) are validated in Italian, but neither of the two questionnaires was correlated with an instrumental examination. The aim of the present study is to improve the GERD-Heal...

Background: Non-alcoholic fatty liver disease (NAFLD) is a major cause of liver disease. Very low-calorie ketogenic diets (VLCKD) represent a feasible treatment as they induce profound weight loss and insulin resistance (IR) improvement. Despite the recognized benefits on NAFLD deriving from pharmacological administration of fibroblast growth fact...

First identified as a feasible treatment for intractable epilepsy, the ketogenic diet (KD) has recently gained popularity thanks to growing evidence on applications such as weight loss, most importantly, but also NAFLD, cancer, neurologic conditions and chronic pain. As with any treatment, whether pharmacologic or not, the KD might not be an approp...

Background The impact of sleeve gastrectomy (SG) on gastroesophageal reflux disease (GERD) is still greatly debated. Most of the current evidence available is solely based on symptom evaluation or medication usage, while a minority have implemented objective functional measurements. Objectives To better comprehend the pathophysiological mechanisms...

Context We compared the efficacy, safety and effect of 45-day isocaloric very-low-calorie ketogenic diets (VLCKDs) incorporating whey, vegetable or animal protein on the microbiota in patients with obesity and insulin resistance to test the hypothesis that protein source may modulate the response to VLCKD interventions. Subjects and Methods Forty-...

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Non-alcoholic fatty-liver disease (NAFLD) is frequent in obese patients and represents a major risk factor for the development of diabetes and its complications. Bariatric surgery reverses the hepatic features of NAFLD. However, its mechanism of action remains elusive. We performed a comprehensive analysis of the mechanism leading to the improvemen...

Obesity is a worldwide disease, with substantial morbidity and mortality. The placement of intragastric balloons (IGBs) is an option for the treatment of obesity. Three IGBs are FDA-approved (Orbera, ReShape Duo, and Obalon) with others likely soon to follow. IGBs have been shown to be safe, effective, and relatively straightforward to place and re...

Background It is generally accepted that the efficacy with an intragastric balloon decreases after the first 4 months of treatment. Aim of this study is to evaluate if the association of a very low-calorie ketogenic diet (VLCKD) can improve the results in terms of weight loss parameters and co-morbidities, as compared to usually prescribed low-calo...

Background and study aims: Endoscopic submucosal dissection (ESD), a minimally invasive treatment for early gastrointestinal (GI) cancer, is considered challenging and risky in the colorectum. As such, most patients undergoing ESD are hospitalized due to the perceived increased risk of adverse events. The aim of this study was to compare the costs...

Context: Sirtuins (SIRTs) are NAD+-dependent deacetylases, cellular sensors to detect energy availability, and modulate metabolic processes. SIRT1, the most studied family member, influences a number of tissues including adipose tissue. Expression and activity of SIRT1 reduce with weight gain and increase in conditions of starvation. Objective: To...

Background Morbidly obese patients are affected by gastroesophageal reflux disease (GERD) and hiatal hernia (HH) more frequently than lean patients. Because of conflicting results, the indication to sleeve gastrectomy (SG) in patients with GERD is still debated. Objectives To evaluate the incidence of GERD on the basis of clinical, endoscopic, and...

Background: Since the great diffusion of laparoscopic treatment of obesity, there is a growing interest concerning the learning process for those surgeons who undertake the bariatric activity. However, papers analyzing the learning curve (LC) for sleeve gastrectomy (SG) are still scarce. This study aims to investigate whether the LC for SG of a no...

The first intragastric balloon was launched in the market 30 years ago. From then, different intragastric prosthesis have been presented and used worldwide. There are, now, one billion overweight/obese persons worldwide. Only some of those patients express the desire or are able to undergo surgical operation. At present there is no medical cure for...

Background: Laparoscopic sleeve gastrectomy (SG) has gained great popularity as a stand-alone bariatric procedure because short- and mid-term outcomes in terms of weight loss and resolution of co-morbidities have been very positive. However, long-term results from large series still are sparse. Objectives: To evaluate the long-term clinical outc...

Sirtuins (SIRTs), ubiquitous deacetylases, are main regulators of energy homeostasis and metabolism. SIRT1 has a positive impact on obesity, diabetes mellitus, liver steatosis, and other metabolic disorders. Lean subjects have higher expression of SIRT1 in the adipose tissue compared to obese. However, it is not known whether weight loss associates...

Background and aims: The Orbera Intragastric Balloon (IGB) System has been widely used outside the United States (US) as an effective adjunct to lifestyle modification in the management of mild to moderate obesity. We performed a systematic review and meta-analysis to summarize the out of the US safety and efficacy experience with this IGB system i...

Aims: Reinforcement of the staple line is one of the most debated technical aspects concerning laparoscopic sleeve gastrectomy (LSG). Different buttressing methods have been proposed and demonstrated to be effective in reducing the incidence of staple line bleeding, although data concerning their effort on staple line leakage are not consistent. T...

The worldwide spreading of “diabesity,” the recent neologism for morbid obesity and type 2 diabetes mellitus (T2DM), has reached dramatic proportions, leading to a significant reduction of life expectancy. Medical therapy for obesity has a very limited success rate in the long term. At present weight loss surgery appears to be effective both on wei...

Sleeve gastrectomy (SG) is a technically simple surgical procedure with low complications rate and negligible long-term nutritional deficiencies.

There is no medical cure for obesity and, despite the numerous dietary treatments, the natural course of the disease is characterized by an ongoing, sometimes unstoppable, weight gain. There are now one billion overweight or obese persons worldwide, but only some of these patients express the desire or are able to undergo a surgical operation. In t...

Obesity is a major risk factor for several chronic diseases. The BioEnterics(®) Intragastric Balloon (BIB(®)) is used worldwide as a short-term (6 months) treatment in morbid obese patients. However, removal of BIB(®) past 6 months is a common occurrence in clinical practice often as a result of patient factors. The aim of the present Italian multi...

Obesity is a major public health concern. As more bariatric surgical procedures are performed, the need for the endoscopist to recognize and treat early and late complications of weight loss surgical procedures is increasing. The types of anastomotic complication after bariatric surgery are very different, ranging from small ulceration successfully...

The intragastric balloon has been reported to be a safe and effective tool for temporary weight loss. The aim of this study is the evaluation of the possible predictive role of intragastric balloon when used before laparoscopic adjustable gastric banding. A longitudinal multicenter study was conducted in patients with body mass index (BMI)>35 kg/m(...

Background Morbid obesity is an increasing health problem. Dietary intervention often fails in the medium to long term, and surgery is the gold standard. Intragastric balloon is a valuable treatment in the short–term, and multiple balloon treatment has been shown to be effective in the medium term. The aim of this study was to investigate the effic...

Eating disorders are a group of conditions characterised by abnormal eating habits. Greater than 50 % of patients with eating disorders have an 'eating disorder not otherwise specified' (EDNOS). No specific tools exist to evaluate EDNOS, and patients are identified only with a diagnosis of exclusion from the other eating disorders. The BioEnterics®...

Background: The objective of this study is the comparison of a new intragastric balloon recently introduced, the Adjustable Balloon System (ABS), with the BioEnterics intragastric balloon (BIB) in terms of tolerance, safety, and weight loss parameters. Methods: A case-control study was done: 40 patients were matched with 80 controls. To achieve...

Background: The request to lose weight is expanding not only in obese and morbidly obese patients but also in overweight patients affected by co-morbidities as diabetes and hypertension and who do not tolerate diet regimen or lifestyle changes. The aim of this study is a multicenter evaluation of outcomes of intragastric balloon in overweight pati...

Background: Laparoscopic adjustable gastric banding (LAGB) has proven to be a safe and effective surgical treatment for morbid obesity. It can be a simple, fast, reversible, anatomy-preserving procedure. Despite these advantages, its long-term efficacy came into question by the occurrence of complications such as intragastric band migration. Consi...

The article discusses the epidemiology, diagnosis and treatment of obesity which represents an emerging problem in Western countries. The WHO has estimated that in 2015 about 2.3 billion of people will be overweight and more than 700 million will be obese. The bariatric surgery is considered the "gold standard" for morbid obesity. Therefore for end...

Different anesthesiological techniques are currently used for intragastric balloon positioning and removal. The aim of this study is to compare different anesthesiological approaches for balloon positioning and removal in a large multicentric patient population. Retrospective multicenter study was conducted. From May 2000 to April 2008, 3,824 patie...

Approximately 1.6 billion adults are overweight, more than 400 million adults are obese. Bariatric surgery is currently considered the "gold standard" for treatment of morbid obesity. We can divide the existing endoluminal treatment in prosthesis and suture for endoluminal gastric restriction. Endoluminal surgery has great potential for an approach...

Gastrogastric fistula is one of the complications that can occur after vertical gastroplasty surgery for weight loss. We describe a novel sleeve gastrectomy technique to treat a proximal gastrogastric fistula after vertical gastroplasty.

Aim of this study is to compare the efficacy of BioEnterics Intragastric Balloon (BIB®) followed by diet with BIB followed by another BIB. A prospective study was designed: a homogeneous group of 100 obese patients (age range 25-35, BMI range 40.0-44.9, M/F ratio 1/4) was allocated into two groups according to procedure: BIB (6 months) followed by...

Laparoscopic antireflux surgery (LARS) represents the gold standard in the treatment of gastroesophageal reflux disease with or without hiatal hernia. It offers excellent long-term results and high patient satisfaction. Nevertheless, several studies have reported a high rate of intrathoracic wrap migration or paraesophageal hernia recurrence. To re...

To compare the efficacy of laparoscopic sleeve gastrectomy (LSG) and BioEnterics intragastric balloon (BIB) to lose weight and comorbidities after 12 months of follow-up before a more invasive bariatric procedure. From January 2004 to December 2006, 40 patients underwent laparoscopic sleeve gastrectomy (LSG) as a first step in biliopancreatic diver...

Background: Very few studies have reported results of the BioEnterics Intragastric Balloon (BIB) at > or =12 months follow-up. The aim of this study is the retrospective evaluation of the results of BIB placement compared to diet regimen alone. Methods: From January 2005 to June 2006, 130 outpatients underwent a structured diet plan with simple...

The BioEnterics Intragastric Balloon (BIB) System in association with restricted diet has been used for the short-term treatment of morbid obesity. Aim of this study was to evaluate the real, short term, efficacy of the BIB for weight reduction in morbidly obese patients by using a prospective, double-blind, randomised, sham-controlled, crossover s...

The temporary use of the BioEnterics Intragastric Balloon (BIB) in morbidly obesity is increasing worldwide. The aim of this study is the evaluation of the efficacy of this device in a large population, in terms of weight loss and its influence on co-morbidities. Data were retrospectively recruited from the data-base of the Italian Collaborative St...

Intragastric prosthesis (Lap-Band, BioEnterics Co., Carpinteria, CA, U.S.A.) migration is one of the major long-term complications of laparoscopic adjustable silicone gastric banding. The causes, clinical signs, timing, and overall incidence of band entrapment have not been prospectively investigated in a large series. The purpose of this study was...

Intragastric prosthesis (Lap-Band. BioEnterics Co., Carpinteria, CA, U.S.A.) migration is one of the major long-term complications of laparoscopic adjustable silicone gastric banding. The causes, clinical signs, timing, and overall incidence of band entrapment have not been prospectively investigated in a large series. The purpose of this study was...

Since laparoscopic Nissen fundoplication was first described by Cuschieri in 1989 and later by Dallemagne in 1991, this procedure has been widely employed for the treatment of symptomatic gastroesophageal reflux disease (GERD) and/or hiatal hernia. However, a relatively high incidence (7-11%) of intrathoracic Nissen valve migration/paraesophageal h...

The excessive accumulation of cholesterol absorbed from bile by the gallbladder impairs its contractility and favours gallstone formation. The total low plasma and high density lipoprotein cholesterol concentrations are associated with gallstone disease. To investigate the effect of plasma lipoproteins on gallbladder cholesterol and phosphatidylcho...

In this paper a novel laparoscopic approach to the left adrenal gland by the transabdominal anterior route is presented. This approach avoids an extensive viscera dissection to gain access to the left adrenal gland. The first step of the procedure is the division of the gastrophrenic ligament and the section of 1 or 2 short gastric vessels in order...

In our initial experience of four cases from March to November 1994, large paraesophageal hernias were repaired by conventional primary closure of the hiatus with interrupted, nonabsorbable sutures, adding a 360 degrees fundoplication. In all four cases the hernia recurred. Subsequently, we modified the procedure. The technique and results are desc...

The relationship between gastric mucosal damage induced by stress, peptides present in the gastric mucosa and is not clear. Aim of this study was to determine whether cold-restraint stress affected the release of gastric somatostatin, gastrin and in the isolated perfused stomach preparation. Male Sprague-Dawley rats were used, 12 cold-restraint str...

An endoscopic screening was carried out during the period between July 1989 and December 1991 in the Municipality of Roccagorga (LT) in order to: a) evaluate the presence of various forms of gastritis and pre-cancerous lesions; 2) verify the effect of the administration of prostaglandins (Misoprostol) on the evolution of superficial chronic gastrit...

The role of prostaglandins in peptic ulcer disease and their relation to Helicobacter pylori infection remain controversial. This study sought to compare the effects of oral nizatidine and ranitidine on the gastric mucosal release of prostanoids in duodenal ulcer (DU) patients and to correlate prostanoid concentrations with H. pylori status. Twenty...

Laparoscopic cholecystectomy is a valid alternative to open cholecystectomy. The Authors present their experience in the management of 208 consecutive patients. The low incidence of complications, the short hospital stay as well as earlier return to work, and lower medical expenses are the advantages of laparoscopic surgery. The latter is, therefor...

Sixty-two patients with gallstones or other benign disease of the gallbladder were candidated to laparoscopic cholecystectomy from November 1990 to March 1991. This technique was successfully performed in 96.7% of cases (60 patients). The mean operative time was 60.3 minutes (27-120) and was shown to significantly correlate to the dimensions of sto...

The effect of somatostatin-14 (SST), at doses utilized in clinical practice, on gastric intraluminal prostaglandin (PG) E2 release was evaluated in 8 endoscopically normal subjects, in 6 patients with benign gastric ulcer and in 8 patients with gastric adenocarcinoma. In normal subjects, SST induced a significant increase in gastric intraluminal PG...