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Robert A Hart, Robin C Dobos, Linda L Agnew, Neil A Smart and James R McFarlane

leptin in male mice measured as percentage of dose (GI Tract – gastrointestinal tract and contents; Other tissues – pooled data for testes, epididymides, seminal vesicles, epididymal fat, heart, lungs and brain). The amount of radiolabelled

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Alexis Sudlow, Carel W le Roux and Dimitri J Pournaras

Bariatric surgery is established as a highly effective treatment for obesity and related metabolic complications. Although once seen as a last resort for patients with obesity, given the data demonstrating the profound weight loss, improvement in comorbidity and safety, perceptions have since shifted. There is evidence from 12 RCTs demonstrating its safety and efficacy in terms of weight loss which is sustained in the long term with a resultant improvement in co-morbidity. Clinicians are increasingly recognising the importance of timely intervention to maximise the effects of bariatric surgery, particularly in light of the low likelihood of being able to adequately manage patients with medication or lifestyle interventions alone. The inclusion of bariatric surgery in the standard treatment algorithm has been a step forward in the approach to treating patients with obesity. What remains challenging for clinicians is knowing which procedure is most beneficial to patients. There is no level one data demonstrating the superiority of one procedure over another. Head to head RCTs are ongoing which may shed light on this question; however, it is likely that there is no single procedure that will be demonstrated to be the gold standard. Herein we review the most commonly performed procedures along with the evidence available to support their effects with regards to weight loss and metabolic changes along with their limitations and recognised risks. The aim is to provide a general framework to allow clinicians to take advantage of the variety of operative approaches to tailor their treatment strategy to the individual patient.

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Logan Mills, Panagiotis Drymousis, Yogesh Vashist, Christoph Burdelski, Andreas Prachalias, Parthi Srinivasan, Krishna Menon, Corina Cotoi, Saboor Khan, Judith Cave, Thomas Armstrong, Martin O Weickert, Jakob Izbicki, Joerg Schrader, Andreja Frilling, John K Ramage and Raj Srirajaskanthan

Small non-functioning pancreatic NETs (pNETs) ≤2 cm can pose a management dilemma in terms of surveillance or resection. There is evidence to suggest that a surveillance approach can be considered since there are no significant radiological changes observed in lesions during long-term follow-up. However, other studies have suggested loco-regional spread can be present in ≤2 cm pNETs. The aim of this study was to characterise the prevalence of malignant features and identify any useful predictive variables in a surgically resected cohort of pNETs. 418 patients with pNETs were identified from 5 NET centres. Of these 227 were included for main analysis of tumour characteristics. Mean age of patients was 57 years, 47% were female. The median follow-up was 48.2 months. Malignant features were identified in 38% of ≤2 cm pNETs. ROC analysis showed that the current cut-off of 20 mm had a sensitivity of 84% for malignancy. The rate of malignant features is in keeping with other surgical series and challenges the belief that small pNETs have a low malignant potential. This study does not support a 20 mm size cut-off as being a solitary safe parameter to exclude malignancy in pNETs.

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Amalie R Lanng, Lærke S Gasbjerg, Natasha C Bergmann, Sigrid Bergmann, Mads M Helsted, Matthew P Gillum, Bolette Hartmann, Jens J Holst, Tina Vilsbøll and Filip K Knop

FGF21 secretion and it remains obscure whether pancreatic or gut-derived hormones are involved in alcohol-induced secretion of FGF21. The gastrointestinal tract plays a major role in glucose, protein and lipid metabolism; and energy

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Stefan Schulz, Anika Mann, Benjamin Novakhov, Hugh D Piggins and Amelie Lupp

adjacent normal tissue, which was also analysed. In addition, tumour-free human tissue samples from lung, heart, liver, gallbladder, different parts of the gastrointestinal tract, pancreas, kidney, spleen, tonsils, thymus and lymph nodes ( n =6 each) were

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Merete Gedde-Dahl, Espen Thiis-Evensen, Andreas Myklebust Tjølsen, Kjerstin Skrede Mordal, Morten Vatn and Deidi S Bergestuen

Introduction Gastroenteropancreatic neuroendocrine tumors (NETs) are rare tumors of the gastrointestinal tract arising from cells of the neuroendocrine system. These cells are known for their capacity to produce various peptides and hormones

Open access

Gaëtan Prévost, Marie Picot, Marie-Anne Le Solliec, Arnaud Arabo, Hind Berrahmoune, Mouna El Mehdi, Saloua Cherifi, Alexandre Benani, Emmanuelle Nédélec, Françoise Gobet, Valéry Brunel, Jérôme Leprince, Hervé Lefebvre, Youssef Anouar and Nicolas Chartrel

the distribution of 26RFa and its receptor all along the gastrointestinal tract and in the pancreas and determined the response of this peptidergic system to an oral glucose challenge in obese patients vs healthy volunteers. Materials and methods

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Lilit Egshatyan, Daria Kashtanova, Anna Popenko, Olga Tkacheva, Alexander Tyakht, Dmitry Alexeev, Natalia Karamnova, Elena Kostryukova, Vladislav Babenko, Maria Vakhitova and Sergey Boytsov

conditions. The GM composition has gained more attention with the development of culture-independent techniques. Most of the microorganisms reside in the gastrointestinal tract. Up to 90% of the GM belongs to Bacteroidetes, Firmicutes, and Actinobacteria

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Annieke C G van Baar, Andrei Prodan, Camilla D Wahlgren, Steen S Poulsen, Filip K Knop, Albert K Groen, Jacques J Bergman, Max Nieuwdorp and Evgeni Levin

in subjects with type 2 diabetes ( 5 ). Rerouting of nutrients to L cell-rich parts of the gastrointestinal tract, as seen after gastric bypass surgery, enhances the postprandial GLP-1 responses ( 6 ), which in turn – like exogenous administration of

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Charlotte Janus, Dorte Vistisen, Hanan Amadid, Daniel R Witte, Torsten Lauritzen, Søren Brage, Anne-Louise Bjerregaard, Torben Hansen, Jens J Holst, Marit E Jørgensen, Oluf Pedersen, Kristine Færch and Signe S Torekov

). Dependent on intensity, physical activity causes mechanical bouncing, changes neuroendocrine activity, and shifts blood flow away from the gastrointestinal tract towards the lungs and working muscles ( 10 , 11 ). These changes may affect gastrointestinal