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Response to Bariatric News article

Peter Small responds to MGB results in weight-loss but linked to cancer

It was my unit that presented the early results with MGB and I take exception to your headline, “MGB results in weight-loss but linked to cancer”. Before we undertook the first MGB, we extensively researched all published human data on this procedure, including that on hypothetical risk of cancers, and have published our findings [1-2]. There is now published experience of more than 6000 procedures with this procedure with reasonably long follow-up and it is being performed by a large number of surgeons across the world [1, 4].

It is worth noting that a recent review by Scozzari et al has not shown any oesoophago-gastric cancers after Mini Gastric Bypass [3]. Furthermore, we did not find any reports of a higher gastric or oesophageal cancer rate in other surgical conditions associated with biliary reflux. In addition, symptomatic gastro-oesophageal biliary reflux was not found to be a major problem with this procedure [1-2].

The study by Bennett and colleagues derives conclusions largely from in vitro and animal studies. It would be interested to know if they also included human studies in their review. We look forward to reading their full paper. In the mean time, we are unable to justify not offering a procedure with “benefits of reduced peri-operative complications” (as identified by Bennett and colleagues), to suitable patients.

Your headline perpetuates the myth that MGB is a proven cancer-inducing operation, which is extremely unhelpful when trying to provide an objective assessment of the procedure. Academics usually wait for research results to be published in scientific journals before reacting to the findings. Science reporters should do the same, especially when suggesting cancer may be an end result.

Mr Peter Small, Bariatric Unit, Sunderland Royal Hospital, Sunderland, UK

References:

  1. Mahawar KK, Jennings N, Brown J, Gupta A, Balupuri S, Small PK. "Mini" gastric bypass: systematic review of a controversial procedure. Obes Surg 2013; 23(11): 1890-8.
  2. Mahawar KK, Carr WR, Balupuri S, Small PK. Controversy surrounding 'mini' gastric bypass. Obes Surg 2014; 24(2): 324-33.
  3. Scozzari G, Trapani R, Toppino M, Morino M. Esophagogastric cancer after bariatric surgery: systematic review of the literature. Surg Obes Relat Dis 2013; 9(1): 133-42.
  4. Musella M, Susa A, Greco F, De Luca M, Manno E, Di Stefano C, Milone M, Bonfanti R, Segato G, Antonino A, Piazza L. The laparoscopic mini-gastric bypass: the Italian experience: outcomes from 974 consecutive cases in a multicenter review. Surg Endosc 2014; 28(1): 156-63.

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