In Vivo Metabolic Testing & Mechanisms of Action of EBMTs

Video Transcription

Video Summary

In the video presentation, Dr. Shelby Sullivan and Dr. Picamal Girapino discuss the mechanisms of actions of various endoscopic bariatric and metabolic therapies (EBMTs). They explain that different EBMTs work through different mechanisms and have varying effects on weight loss and metabolic improvements.<br /><br />First, they discuss gastric interventions such as intragastric balloons, transpyloric shuttles, endoscopic sleeves, and aspiration therapy. Gastric interventions mainly work by altering gastric emptying and gut hormones. For example, intragastric balloons delay gastric emptying, leading to prolonged satiety and reduced calorie intake. Transpyloric shuttles also delay gastric emptying, while endoscopic sleeves accelerate gastric emptying. These interventions also affect levels of hormones like ghrelin, glucagon-like peptide 1 (GLP-1), and peptide YY (PYY), which play a role in hunger and satiety.<br /><br />Next, they discuss small bowel interventions such as the duodenal jejunal bypass liner (endobarrier) and duodenal mucosal resurfacing (RAVITA). Small bowel interventions provide direct metabolic improvements, often independent of weight loss. They affect gut hormones like GLP-1 and PYY, which regulate insulin secretion and satiety. These interventions may also influence bio-acids and the foregut-hindgut hypothesis, which relate to the secretion of incretin hormones and their effects on glucose metabolism.<br /><br />While gastric interventions primarily focus on weight loss, small bowel interventions have direct metabolic effects on conditions like diabetes and fatty liver. Both types of interventions can be personalized based on factors like gastric emptying rate and hormone levels.<br /><br />Overall, understanding the mechanisms of action of EBMTs can help guide personalized therapy and combination treatments for patients with obesity and metabolic diseases. The presenters emphasize the need for further research in this field to improve outcomes and decrease the non-responder rate.

Keywords

EBMTs

gastric interventions

small bowel interventions

gut hormones

weight loss

insulin secretion

satiety

glucose metabolism

diabetes

metabolic diseases