Qazi Corner, Edition 6: Bariatric Surgery in Liver Disease, Glucagon, and Cuffitis Outcomes

Taha Qazi, MD

Credit: Cleveland Clinic

In this issue of Qazi Corner, we have 3 amazing articles looking at a variety of issues in IBD, as well as GI care and liver care.

The first article is by a fellow named Dr. Steven Firkins who is interested in bariatric endoscopy. He looked at the National Inpatient Sample and evaluated whether patients with cirrhosis who have a common condition called metabolic-associated liver disease do better when they have bariatric surgery or not. This is a large retrospective study suggesting that overall, patients who get bariatric surgery for cirrhosis in the context of MASLD actually did very, very well. The implications of this study suggest that not only bariatric surgery, but basically bariatric endoscopy and bariatric procedures, are very beneficial for these patients, not only from a hepatology perspective, but from a mortality perspective as well.

The second article is by a colleague of mine, Dr. Roma Patel, one of our fantastic fellows at the Cleveland Clinic, who is reviewing the role of glucagon in the context of esophageal impactions. Esophageal impactions are very common. They normally happen around 5 o'clock in the morning or 5 o'clock in the evening, when people are eating and all of a sudden food gets stuck. A common noninterventional strategy is to use glucagon, which is an agent for the management of these esophageal impactions. Unfortunately, this study, which was done very recently, showed that glucagon had no impact on esophageal impactions. This tells us that we should be coming in sooner and getting these endoscopic procedures in and making sure that we are able to get these areas alleviated from this impaction movement and moving forward with that.

Lastly, I want to highlight the work of a medical student, Dr. Carter Powers, who's doing a lot of amazing work with me in the pouch and the cuff. He was able to evaluate whether patients who have pouches and also have a condition called cuffitis have long-term complications related to the disease. He found that patient with cuffitis had higher rates of pouch surgeries and higher rates of ileostomy creation and pouch failure. What he determined is that in patients who have severe cuff inflammation, they also have higher rates of fistula formation and higher rates of stricture formation. It’s a really interesting idea. How do we change that? Do we trend toward treating these patients sooner with medications for cuffitis? I think it still needs to be seen, but I think this provides a great deal of context as to how we manage this really complicated cohort of patients as we move forward.