Welcome to our weekly round-up of the latest bariatric and obesity-related papers published in the medical literature. As ever, we have looked far and wide to give you an overview of papers including no difference in expenditure for bariatric patients, gastric pouch resizing is a valuable surgical option for weight recurrence, calcium citrate vs calcium carbonate to reduce postsurgical PTH, anaemia ten years after surgery, maternal and neonatal risks after surgery, American Foregut Classification is superior to Hill Classification, and more (please note, log-in maybe required to access the full paper).
Health Expenditures After Bariatric Surgery A Retrospective Cohort Study
Bariatric surgery results in lower medication expenditures vs nonsurgical patients, but not lower overall long-term expenditures, researchers from Duke University, Durham, NC, have reported.
Writing in Annals of Surgery, they compared expenditures between surgical and matched nonsurgical patients in a retrospective cohort study. They compared total outpatient, inpatient and medication expenditures three years before and 5.5 years after surgery from 22,698 bariatric surgery [n=7127 Roux-en-Y gastric bypass (RYGB), 15,571 sleeve gastrectomy (SG)) patients and 66,769 matched nonsurgical patients. They also compared expenditures between RYGB and SG.
The estimated total expenditures were similar between surgical and nonsurgical groups before surgery ($27 difference), but increased six months before surgery for surgical patients, and decreased below preperiod levels for both groups after three to 5.5 years to become similar (difference at 5.5 years =-$6). Long-term outpatient expenditures were similar between groups. Surgical patients’ lower long-term medication expenditures ($314 lower at 5.5 years) were offset by a higher risk of hospitalisation.
Total expenditures were similar between patients undergoing RYGB and SG 3.5 to 5.5 years after surgery.
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Gastric Pouch Resizing for Recurrent Weight Gain After Roux-en-Y Gastric Bypass—Does It Have Its Rational?
Gastric pouch resizing (GPR) for recurrent weight gain after primary RYGB is a safe procedure resulting in weight stabilisation and resolution of obesity-associated comorbidities, and is therefore a valuable surgical option in well-selected patients, according to researchers from the University Hospital Zurich, Zurich, Switzerland.
Reporting in Obesity Surgery, they analysed the effect of GPR after primary RYGB on long-term weight loss, course of comorbidities, safety, and patient satisfaction In total, 48 patients underwent GPR between 2016 and 2020 at the University Hospital of Zurich. An additional, 37 patients participated in a survey to evaluate patient-reported outcome measures (PROMs).
The mean for GPR after RYGB was 106.2±45.5 months at a mean BMI of 39±5.4 kg/m2. Mean follow-up was 55.9±18.5 months with a mean BMI 1- and 5-years postoperative of 37±5.5 kg/m2 and 35±7.5 kg/m2, respectively. Obesity-associated comorbidities were resolved in 53% of patients at follow-up (p<0.05). Minor post-operative complications occurred in 12.5% and major complications occurred in 10.4% of patients. The PROMs showed high levels of satisfaction after GPR.
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Comparison of calcium citrate and calcium carbonate absorption in patients with a Roux-en-Y Gastric Bypass, Sleeve Gastrectomy, and One-Anastomosis Gastric Bypass: A double-blind, randomized cross-over trial.
Calcium citrate is significantly better than calcium carbonate in reducing parathyroid hormone (PTH) levels, enhancing relative calcium bioavailability and increasing urinary calcium excretion, according to a study led by researchers from Alexandria University, Alexandria, Egypt.
Published in SOARD, the study compared the efficacy of calcium citrate and calcium carbonate supplementation on Ca absorption following RYGB, LSG and OAGB surgeries. This randomised, double-blinded, crossover study included 150 participants six months post-metabolic bariatric surgery (MBS). The intestinal absorption of calcium carbonate and calcium citrate among groups was divided by surgical procedure and compared over eight hours of testing.
In total, 50 per each surgery group were included with an average age of 40.5±7.6 years, of whom 128 (85.3%) were female. The participants' average BMI was 30.3±2.0 kg/m2. The average time elapsed after MBS was 9.8±1.0 months. Calcium citrate intake significantly lowered parathyroid hormone (PTH) levels and showed enhanced relative calcium bioavailability vs. calcium carbonate. PTH levels were notably reduced from 3 to 6 hours post-administration with calcium citrate, with significant differences (p<0.001).
Calcium citrate also demonstrated superior relative bioavailability, as evidenced by a higher AUC0-8h of 76.1mg/dL·h versus 74.7mg/dL·h for carbonate (p=0.001) and a Cmax of 9.8mg/dL vs. 9.5mg/dL for carbonate (p<0.001). Additionally, urinary calcium excretion over nine hours was significantly greater in the citrate group at 83.7mg/dL vs. 68.6mg/dL for carbonate (p<0.001).
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Anemia in patients ten years after bariatric surgery
Anaemia is a significant but manageable condition five and ten years after bariatric surgery, according to a study by Swedish researchers, however, despite the prescription of oral iron supplements to 45% ten years after surgery, the Hb levels could still not be fully restored.
Reporting in International Journal of Obesity, the study included 39,992 individuals (mean age 41 years, range 18–74, 77% women) from the Scandinavian Obesity Surgery Registry (SOReg).
At five years, 2838/13,944 women (20.3%) and 456/4049 men (11.2%) had anaemia. After ten years, 644/3400 women (18.9%) and 178/947 men (18.8%) had anaemia. The use of oral iron increased from 40 to 45%, and the need for parenteral iron intake increased from 5 to 11%.
The study authors emphasised the importance of follow-up visits and continuous supplementation.
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Maternal and neonatal risks and outcomes after bariatric surgery: a comparative population based study across BMI categories in Qatar
Women in the post-bariatric surgery (BS) group were more likely to have low-birth-weight neonates amongst term babies than women with obesity and overweight, according to a study by researchers form the Hamad Medical Corporation, Doha, Qatar.
Writing Scientific Reports, the primary aim of this study is to assess the factors associated to women who have undergone BS. The study included 6,212 parturient women, of which 315 had a history of BS, while 5897 with no BS history. Qatari women, aged 35 and higher, with parity > 1, diabetes, and hypertension were more likely to be in the post-BS group. Women in the post-BS group were found to be more likely to have a caesarean delivery (37.5% vs. 24%), preterm babies (10% vs. 7%) and stillbirth (1.6% vs. 0.4%) vs. tthe normal weight women group. Moreover, post-BS women had a higher risk of low-birth-weight neonates than women with obesity (15% vs. 8%), overweight (15% vs. 7%) and normal weight (15% vs. 8%).
Pregnancies with post-BS should be considered a high-risk group for certain medical outcomes and should be monitored closely, however, these findings may guide the future clinical decisions of antenatal and postnatal follow-up for post-BS women, they concluded.
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American Foregut Classification is Superior to Hill Classification in Evaluation of the Gastroesophageal Junction
The American Foregut Classification (AFS) score can classify the gastroesophageal junction (GEJ) with moderate interobserver agreement and is superior to the Hill grade in predicting acid exposure time, according to a study by researchers from Johns Hopkins Hospital, Baltimore, MD.
Writing in Foregut: The Journal of the American Foregut Society, they performed a multi-reader validation study on images collected from patients who underwent endoscopic evaluation of reflux with hernia provocation using both AFS and Hill classification.
In total, 64 eligible patients were identified. Inter-rater reliability was substantial for AFS classification (K=0.65) and fair for Hill classification (K=0.28). The AFS grade demonstrated moderate overall correlation with AET (ρ=0.36) and the Hill grade demonstrated overall weak correlation (ρ=0.28). They reported that no single component of the AFS score performed significantly better in predicting pathologic reflux than the AFS grade (AFS F=9.93, p=0.0025) and there was no significant difference in overall grading between expert- and non-expert readers (ρ=0.38 vs ρ=0.29).
They concluded that AFS grade has better predictive power than the individual components used in scoring and is robust to differences in reader experience.
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