Professor Lord’s laboratory has been awarded a prestigious NHMRC Ideas Grant to study Barrett’s oesophagus and oesophageal adenocarcinoma. The project – which is lead by chief investigator Professor Lord – will be undertaken over the course of three years in collaboration with leading scientists at CSIRO and oesophageal experts in gastroenterology and pathology at other centres. There will be opportunities for patients to participate in studies for this project.
Many individuals are experiencing regain of some of the weight they lost after bariatric (weight loss) surgery. Weight regain is a very common finding after bariatric surgery and can be especially disappointing if the weight regain is associated with deterioration in weight related health problems. For example, patients who were able to cease insulin use after their bariatric operation may have worse diabetic control with weight regain and may be faced with needing insulin therapy again.
Unfortunately, weight regain is not unexpected after weight loss surgery. This is the case for all weight loss operations and occurs regardless of how well your surgeon performed the initial operation.
In the field of clinical medical research, we regard data collected through prospective trials, and especially prospective randomised controlled trials with their strict trial requirements, as especially valuable. A number of prospective trial study results demonstrate how common the problem of weight regain is after bariatric surgery. In the landmark STAMPEDE randomised trial of bariatric surgery versus intensive medical therapy for Type 2 diabetes for example, the patients were followed for five years after surgery. In this study the minimum weight was reached by patients, on average, at approximately 1½ - 2 years after surgery. After this the average patient weight slowly increased over the remaining three years of the study. Similar results are found in many other studies.
Professor Lord sees many patients with weight regain after weight loss surgery, and he has a particular interest in this increasingly common problem.
The process for evaluating weight regain after weight loss surgery involves meeting with Dr Lord. He will take a detailed history and often perform an endoscopy (gastroscopy) to directly inspect the current state of your operation. Radiological imaging may also be arranged, such as a video swallow or CT study.
A common scenario is that patients have had a laparoscopic gastric band which resulted in weight loss during the first year or two years after surgery but this weight loss was insufficient and was followed by weight regain. The effectiveness of gastric band surgery seems to depend on the thoroughness of the surgeon’s follow up after surgery but even with the most rigorous multidisciplinary follow up there are many patients for whom the gastric band does not provide adequate long-term weight loss. If you are in the category of inadequate weight loss or weight regain after band surgery you should seek a consultation regarding improving the effectiveness of the band or alternatively removing the band and potentially undergoing one of the other weight loss operations.
Another common scenario is weight regain after laparoscopic sleeve gastrectomy. In some instances this is due to sleeve dilatation. Dr Lord will discuss with you the options to correct this problem. Patients sometimes request re-sleeve but this operation is potentially hazardous as it involves stapling over an existing staple line, which has an increased risk of staple line leak. Dr Lord’s preference is to perform the safer operation of robot assisted gastroplasty which involves folding the staple line, inwards to once again create a narrow sleeve stomach (imbrication of the staple line). Using the robot provides excellent vision for placing the sutures to perform this operation and there is no additional cost for use of the robot at Macquarie University Hospital.
In some instances patients will be asked to consider conversion from band or sleeve to one of the several malabsorptive bypass operations. Gastroesophageal reflux symptoms that are difficult to manage or diabetes requiring insulin treatment would be factors in making a recommendation towards bypass surgery.
Professor Lord's team at the St Vincent's gastro-oesophageal cancer research laboratory Sydney, in collaboration with the sequencing facility at the Garvan St Vincent's Kinghorn Cancer Centre Sydney, have published the first report of the whole transcriptdome of Barrett's oesophagus and oesophageal adenocarcinoma.
This major landmark study has provided great insights into the biology of this disease, including important new information regarding how some patients with Barrett's oesophagus progress to develop oesophageal cancer.
For those interested, here is the link to the publication:
Transcriptdome sequencing publication in Molecular Cancer Research
This month, Professor Lord gave a keynote lecture at the 87th Annual Scientific Congress for the Royal Australasian College of Surgeons (RACS).
Patients with Barrett's oesophagus may be interested in reading an article about Herb, an elderly man who had the endoscopic radiofrequency ablation procedure performed by Professor Lord.
Article: A life saving trial
For more reading material please visit: Research and Publications. There is a reading list located at the bottom of the page.
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