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Long-term gastric band outcomes

23-years study indicates banding has long lasting beneficial effects

The reduced mortality in surgical vs nonsurgical patients was significant in the whole cohort and in patients with diabetes, of borderline significance in patients without diabetes

The preventive effect of gastric banding (GB) on mortality is maintained up to 23 years, according to researcher from Milan, Italy. However, the preventive effect of GB on co-morbidities and on hospital admissions increases with time. The paper, ‘A 23-year study of mortality and development of co-morbidities in patients with obesity undergoing bariatric surgery (laparoscopic gastric banding) in comparison with medical treatment of obesity’, was published in Cardiovascular Diabetology.

In a previous retrospective study, the researchers from Università degli Studi di Milano, ASST Santi Paolo e Carlo, Milan, Istituto Multimedica and Ospedale San Raffaele, Milan, Italy, reported that GB was associated with reduced mortality in patients with and without diabetes, and with reduced incidence of obesity co-morbidities (cardiovascular disease, diabetes, and cancer) at a 17-year follow-up. This latest study was designed to verify the outcomes (mortality and incidence of co-morbidities) at a longer time interval (23 years) in patients undergoing GB or medical weight loss therapy.

All surgery and non-surgical patients were treated with diet, and received standard care (education on eating behaviours, advice on diet and exercise, plus drug treatment for diabetes and hypertension when present); their suggested diet was between 1000 and 1200 kcal/day for women and men (22% protein, 29% lipids, and 49% carbohydrates), respectively, with the aid of a dietitian.

The main outcome measures were death rate and cause of death among patients with diabetes (surgical vs nonsurgical), death rate and cause of death among patients without diabetes (surgical vs nonsurgical) and exemptions and hospital admissions among patients with and without diabetes (surgical vs nonsurgical). Survival was compared across LAGB patients and matched controls using Kaplan–Meier plots adjusted Cox regression analyses.

Outcomes

In total, 383 patients underwent GB (52 with diabetes) and 681 underwent medical treatment (127 with diabetes), during the period 1995–2001. Patients were matched for age, sex, BMI and blood pressure. The final observation period was 19.5±1.87 years (13.4–23.5). Compared to controls, LAGB was associated with reduced mortality (p=0.003), significant in patients with diabetes (p=0.034), borderline significant in patients without diabetes (p = 0.076). LAGB was associated with lower incidence of diabetes (15 vs 75 cases, p=0.001), of CV diseases (61 vs 226 cases, p=0.009), cancer (10 vs 35, p=0.01), renal diseases (0 vs 35, p=0.001) and of hospital admissions (92 vs 377, p=0.001). The mortality rate was 2.6, 6.6, 10.1 and 13.4% in controls at five, ten, 15 and 20 years, respectively; mortality rate was 0.8, 2.5 and 3.1, and 7.4% in LAGB patients at five, ten, 15 and 20 years, respectively.

The reduced mortality in surgical vs nonsurgical patients was significant in the whole cohort and in patients with diabetes, of borderline significance in patients without diabetes. During the first five years there were four deaths (one above median age) in the surgery group and 18 deaths (17 above median age) in the non-surgical group (NS). After exclusion of these patients, the HR was 0.32 (95% CI 0.15–0.69), (Log rank = 0.003).

The researchers revealed that reduced mortality in surgical vs nonsurgical patients was significant in patients aged > 42 years, but not significant in patients aged < 42 years. The causes of death were similar in the two observation periods, and the comparison between surgical vs nonsurgical patients had a reduced level of significance in the follow-up period, in agreement with the reduced overall effect on prevention of mortality.

Figure 1: Mortality in surgical and in matched nonsurgical control patients divided according to median age (42 years): a below median age; b above median age. Number of patients at risk is indicated. Years = since visit 1

According to the researchers, this study represents the longest follow-up evaluation of patients undergoing GB, in comparison with patients receiving weight loss medical treatment. Although the researchers acknowledge that one limitation of the study was that patients were not randomised, at the time this study was conceived, randomisation was deemed unethical, so that prospective studies could not be performed.

“The preventive effect of LAGB on mortality is maintained up to 23 years, even with a decreased efficacy, while the preventive effect of LAGB on incident diseases and on hospital admissions increases with time,” the researchers concluded. “These data indicate that the beneficial effects of LAGB is long lasting.”

To access this paper, please click here

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