{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T10:22:33Z","timestamp":1789640553408,"version":"4.0.0"},"reference-count":45,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T00:00:00Z","timestamp":1759190400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T00:00:00Z","timestamp":1759190400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["dom-pubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Obesity Metabolism"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>\n                      This study evaluated the metabolic efficacy of ForePass\u2014a novel, incision\u2010free, reversible, endoscopically delivered device that mimics biliopancreatic diversion\u2014in growing pigs. The primary aim was the superiority of ForePass over Semaglutide in improving insulin sensitivity (\n                      <jats:italic>S<\/jats:italic>\n                      <jats:sub>I<\/jats:sub>\n                      ). Secondary aims included effects on weight gain, endogenous glucose production (EGP), disposition index (DI), oral glucose rate of appearance, plasma metabolomics, and faecal microbiota.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>\n                      Over 30\u2009days, 12 young Landrace pigs (46.7\u2009\u00b1\u20091.1\u2009kg) received ForePass, twice\u2010weekly Semaglutide, or sham endoscopy. Sample size was calculated a priori for the primary endpoint (\u0394\u2009=\u20090.6\u2009min\n                      <jats:sup>\u22121<\/jats:sup>\n                      \u00b7pM\n                      <jats:sup>\u22121<\/jats:sup>\n                      , SD\u2009=\u20090.3,\n                      <jats:italic>\u03b1<\/jats:italic>\n                      \u2009=\u20090.05, 80% power), yielding\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20094 per group. Body weight was monitored, and oral glucose tolerance testing (OGTT) with stable isotope tracers assessed hepatic glucose disposal.\n                      <jats:italic>S<\/jats:italic>\n                      <jats:sub>I<\/jats:sub>\n                      , insulin secretion, glucose rate of appearance (\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sub>a<\/jats:sub>\n                      ), metabolomics, and faecal microbiota were analysed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      ForePass improved S\n                      <jats:sub>I<\/jats:sub>\n                      more than Semaglutide (2.75\u2009\u00b1\u20090.37 vs. 1.34\u2009\u00b1\u20090.21\u2009min\n                      <jats:sup>\u22121<\/jats:sup>\n                      \u00b7pM\n                      <jats:sup>\u22121<\/jats:sup>\n                      ) and sham (0.78\u2009\u00b1\u20090.46;\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.05). Weight gain was 2.0\u2009kg (4%) with ForePass, versus 16.3\u2009kg (36%) with Semaglutide and 21.1\u2009kg (47%) with sham (\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.0001). Semaglutide reduced weight gain by 11% versus sham (\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.05). DI was 2.6\u2010fold higher with ForePass than Semaglutide and 3.5\u2010fold higher than sham. ForePass reduced oral glucose\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sub>a<\/jats:sub>\n                      by 40% versus Semaglutide and 30% versus sham, while EGP 46% was lower than Semaglutide and 51% lower than sham (\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.0001). Metabolomics showed ForePass increased ketogenic and branched\u2010chain amino acids, whereas Semaglutide raised lactate and alanine. Only ForePass increased faecal\n                      <jats:italic>Akkermansia muciniphila<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>ForePass produced superior insulin sensitivity and weight outcomes versus Semaglutide. Its distinct effects on glucose disposal, metabolomics, and microbiota support development as a reversible, incision\u2010free endoscopic therapy that may bridge the gap between pharmacological and surgical options for obesity and type 2 diabetes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dom.70167","type":"journal-article","created":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T08:36:46Z","timestamp":1759221406000},"page":"7587-7601","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["<scp>ForePass<\/scp>\n                    outperforms Semaglutide in weight control, glucose metabolism, and gut microbiota in swine"],"prefix":"10.1111","volume":"27","author":[{"given":"Sara","family":"Russo","sequence":"first","affiliation":[{"name":"Institute of Translational Medicine and Surgery Universit\u00e0 Cattolica del Sacro Cuore  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Proto","sequence":"additional","affiliation":[{"name":"Institute of Translational Medicine and Surgery Universit\u00e0 Cattolica del Sacro Cuore  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manoel Galvao","family":"Neto","sequence":"additional","affiliation":[{"name":"Bariatric Endoscopy Department of Mohak Bariatric and Robotic Center Sri Aurobindo Medical College  Indore India"},{"name":"Health Weight Loss and Bariatric Surgery Institute Orlando Health  Orlando Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Angelini","sequence":"additional","affiliation":[{"name":"Institute of Translational Medicine and Surgery Universit\u00e0 Cattolica del Sacro Cuore  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha","family":"Pezzica","sequence":"additional","affiliation":[{"name":"Cardiometabolic Risk Laboratory, Institute of Clinical Physiology (IFC) National Research Council (CNR)  Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrizia","family":"Carli","sequence":"additional","affiliation":[{"name":"Cardiometabolic Risk Laboratory, Institute of Clinical Physiology (IFC) National Research Council (CNR)  Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Previti","sequence":"additional","affiliation":[{"name":"Institute of Translational Medicine and Surgery Universit\u00e0 Cattolica del Sacro Cuore  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Emiliana","family":"Caristo","sequence":"additional","affiliation":[{"name":"Institute of Translational Medicine and Surgery Universit\u00e0 Cattolica del Sacro Cuore  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Bove","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences Fondazione Policlinico Universitario A. 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