Journal Watch 16/4/2025

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 Oseberg RCT outcomes, cost-effectiveness of bariatric surgery, BMS combined with non-surgical approaches, revisional surgeries after sleeve gastrectomy and post-RYGB reflux, and more (please note, log-in maybe required to access the full paper).

Effect of gastric bypass versus sleeve gastrectomy on the remission of type 2 diabetes, weight loss, and cardiovascular risk factors at 5 years (Oseberg): secondary outcomes of a single-centre, triple-blind, randomised controlled trial

Gastric bypass was superior to sleeve gastrectomy regarding long-term remission of type 2 diabetes, weight loss and LDL cholesterol concentrations, at the expense of a higher frequency of symptomatic postprandial hypoglycaemia, according to researchers from Norway.

Writing in The Lancet Diabetes & Endocrinology, they reported the effects of gastric bypass and sleeve gastrectomy on type 2 diabetes remission, weight loss and cardiovascular risk factors five years after surgery. Patients received gastric bypass (n=54) or sleeve gastrectomy (n=55), at 5-years 47 patients in the sleeve gastrectomy group and 46 patients in the gastric bypass group were available for follow-up.

The proportions with remission of type 2 diabetes were higher after gastric bypass than after sleeve gastrectomy (HbA1c ≤6·0% 23 [50%] of 46 vs nine [20%] of 44), gastric bypass provided greater loss in bodyweight and lower LDL-cholesterol (treatment difference –0·5 mmol/L [–0·8 to –0·1]). The prevalence of erosive oesophagitis and Barrett's oesophagus was similar between groups, whereas pathological acid reflux occurred more frequently after sleeve gastrectomy. More participants had symptomatic postprandial hypoglycaemia after gastric bypass than after sleeve gastrectomy (15 [28%] vs one [2%]).

“These findings could inform clinical practice and future guidelines regarding the preferred surgical procedure in patients with type 2 diabetes,” the concluded.

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Unveiling the Cost-Effectiveness of Bariatric Surgery: Insights from a Matched Cohort Study

US researchers have found that bariatric surgery is associated with an average 22.6% reduction in health care costs within two years post-index date.

Writing in SOARD, 9432 surgical patients who had a bariatric procedure between January 2017 and December 2019, were matched with 9432 well-matched controls, based on age, BMI, sex, comorbidities and health care costs in the year before the index date. Total and clinical care-specific costs were compared in the two years after the index date (excluding the cost of surgery).

After two years total health care costs were $5,677 lower among surgical patients (p <0.01). In 29 of 35 characteristics examined, health care costs were significantly reduced after surgery. The largest savings were noted among patients with Type 2 diabetes ($15,270), steatohepatitis ($11,648) or ages 50-65 years ($11,105).

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Meta-analysis of randomized controlled trials for the development of the International Federation for Surgery of Obesity and Metabolic Disorders-European Chapter (IFSO-EC) guidelines on multimodal strategies for the surgical treatment of obesity

An international team of researchers have found BMS combined with non-surgical approaches appears more effective than BMS alone in reducing BMI.

Reporting in Diabetes, obesity and Metabolism, they performed a meta-analysis including 25 RCTs enrolling patients undergoing different BMS procedures add-on to other anti-obesity strategies (LSI, MT, OMM or ES) versus BMS alone, with a duration of at least 6 months.

The addition of either OMM (i.e., liraglutide) or EP (i.e., intragastric balloon—IB, endosleeve-ES) to MBS was associated with a significantly lower BMI at the end-point (p=0.040). The addition of liraglutide only to BMS was associated with a greater %EWL%, but not %TWL and TBWL (p=0.008). Three trials evaluated end-point HbA1c, showing a significant reduction in favour of liraglutide as an add-on therapy to BMS (p=0.007).

Further RCTs on combined therapies to MBS for severe obesity are needed to enhance the tailoring of treatment for severe obesity, they concluded.

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Comparison of different revisional surgeries after sleeve gastrectomy: A network meta-analysis

Researchers from Poland have reported single anastomosis duodeno-ileal bypass with sleeve (SADI-S) is the preferred revisional procedure following sleeve gastrectomy due to superior weight loss outcomes and comparable complication rates.

Reporting in Obesity Reviews, their systematic review including 23 studies (3,266 participants). In %EWL, SADI-S (MD 14.80; 95% CrI: 5.38, 24.40) and OAGB (MD 8.28; 95% CrI: 1.99, 14.30) were significantly more effective. In %TWL, SADI-S (MD 9.27; 95% CrI: 1.06, 17.8) showed superior outcomes. No significant differences in morbidity rates were observed among the revisions. SUCRA analysis ranked SADI-S highest for both %EWL and %TWL, and re-LSG as the best choice in regards to morbidity.

They said that further randomised controlled trials are needed to confirm these findings.

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Mechanisms of Gastroesophageal Reflux Post-Roux-en-Y Gastric Bypass: Universal Alteration of the Antireflux Barrier is the Culprit

US researchers have reported that there is a high incidence of hiatal hernia (HH) and esophagogastric junction (EGJ) flap effacement in patients after RYGB, potentially elucidating the persistence of reflux symptoms, including weakly acidic or alkaline reflux, post-RYGB.

Writing in Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, they examined patients who underwent RYGB and subsequent upper endoscopy, conducted by an expert bariatric endoscopist. The primary focus was on pouch endoscopic retrosflexion to evaluate the antireflux barrier (ARB). They gathered data encompassing patient demographics, anthropometrics, comorbidities and findings from esophagogastroduodenoscopy (EGD) at the time of surgery and during follow-up EGD.

Our study included a total of 42 patients, predominantly female (97.5%) and White (100%), with an average age of 53.6±10.6 years and a body mass index (BMI) of 32.9±9.4 kg/m2. They reported all EGDs revealed the presence of a HH of varying sizes. The average HH size was 2.07±0.87cm. The EGJ flap was also effaced in all patients with the majority (90.4%, 38 patients) classified as Hill grade IV and a smaller proportion (9.6%, 4 patients) as Hill grade III. Notably, PPI usage increased from the time of surgery to the time of EGD (69.0% vs. 42.9%, p=0.06).

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Postoperative outcomes following revision or conversion surgery after primary sleeve gastrectomy: an analysis of the MBSAQIP database

US researchers have report that Re-SG and SG-SADI had lower odds of 30-day major complications compared to SG-RYGB, but had significantly higher odds of anastomotic or staple line leak and had longer hospital stays on readmission.

They conducted a retrospective comparative analysis of postoperative outcomes of revision or conversion BMS following primary SG and included patients who underwent any one of: revision SG (Re-SG), Roux-en-Y gastric bypass (SG-RYGB), biliopancreatic diversion/duodenal switch (SG-BPD/DS), single anastomosis duodenoileal bypass (SG-SADI) or one anastomosis gastric bypass (SG-OAGB). The primary outcome was 30-day major complications, defined as Clavien-Dindo Grade >II.

From 33,348 revision/conversions SG-RYGB was the most common (n=27393, 82.1%). Compared to SG-RYGB, the odds of 30-day major complications were lower in Re-SG and SG-SADI. However, both Re-SG and SG-SADI were associated with higher odds of anastomotic or staple line leak. In addition, both Re-SG and SG-SADI resulted in longer hospital stays upon readmission.

“Given its limited indications and significant potential morbidity, Re-SG should not be routinely offered as a revisional procedure for primary SG,” they concluded.

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