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 SADI betters OAGB after failed SG, physician payments are driving robotic bariatric surgery reporting, AFS issues White Paper on the endoscopic assessment of the GE valve after anti-reflux surgery, alcohol use declines after AOM and ingestible capsule releases a burst of drugs directly into the wall of the GI tract, and more (please note, log-in maybe required to access the full paper).
Laparoscopic Single Anastomosis Duodeno-Ileal Bypass Versus One Anastomosis Gastric Bypass as Revisional Procedures after Sleeve Gastrectomy: Meta-analysis and Systematic Review
An international team of researchers has reported that single anastomosis duodeno-ileal bypass (SADI) is a feasible procedure with a favourable outcome compared to and one anastomosis gastric bypass (OAGB) as a revisional surgery following sleeve gastrectomy regarding weight loss at one year with a lower incidence of postoperative biliary reflux.
This meta-analysis and systematic review, published in Obesity Surgery, included four articles (n= 309 patients). Regarding weight loss at 1 year of follow-up, SADI was favourable based on excess weight loss percentage (EWL%) and total weight loss percentage (TWL%). However, at 2 years EWL% did not show a statistically significant difference between the two operations but TWL% was higher in SADI group.
The OAGB group had a significantly higher incidence of biliary reflux (p=0.003) and patients in the SADI group did not develop anastomotic ulcers compared to seven patients in the OAGB group, but the difference was not statistically significant (p=0.07).
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Robotics, money and research: is data or physician payments driving robotic bariatric surgery literature?
Intuitive Surgical open payments have significantly influenced favourable reports in robotic bariatric literature, according to a study led by researchers from Geisinger Health System, Danville, PA.
Reporting in Surgical Endoscopy, they examined the accuracy of conflict of interest (COI) statements and the influence of industry payments on the valuation of the robotic platform and they found robotic favourable manuscripts were significantly less likely to have an adequate COI.
Furthermore, authors of robotic favourable manuscripts were significantly more likely to have a COI, had a significantly a higher Intuitive physician compensation and more likely to have an increase in the amount of compensation by Intuitive Surgical the following year.
The authors stated that the submission of open payments data, to include compensation amounts should be required for manuscript publication or acceptance to surgical conferences.
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American Foregut Society White Paper on the Endoscopic Assessment of the Gastroesophageal Valve after Anti-Reflux Surgery
The AFS Anti-Reflux Barrier Collaborative, writing on behalf of the American Foregut Society, has concluded that a consistent nomenclature should for describing the appearance of the post-surgical valve is essential to develop a better understanding of how variables such as the tightness of the hiatal repair, tightness of the valve collar, and length of the valve can impact the outcome of anti-reflux surgery and predict reflux recurrence.
The white paper analysed the anatomic manipulation and corresponding endoscopic appearance of the EGJ after commonly performed anti-reflux surgery including: (1) 360° anterior/posterior (AP) fundoplication (Nissen); (2) posterior partial fundoplication (Toupet); (3) anterior partial fundoplication (Watson, Dor); (4) magnetic sphincter augmentation; and (5) concomitant hiatal hernia repair with transoral fundoplication (cTIF).
The Collaborative established that when evaluated endoscopically in retroflection, the surgically constructed valve should be described in reference to the angle of His and the extent of anatomic change described in terms of (1) the depth of the anterior and posterior grooves, (2) the apposition of the valve collar to the endoscope, (3) the length of the valve, and (4) the position of the squamocolumnar junction relative to the lip of the valve.
The concluded that current anti-reflux operations share much in common but employ varying degrees of valvular reconstruction leading to distinct endoscopic characteristics.
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Alcohol Use and Antiobesity Medication Treatment
Nearly half of individuals participating in a weight loss programme who were consuming alcohol at baseline, decreased their alcohol use after Antiobesity Medication (AOM) initiation, US researchers have found.
Writing in JAMA Network Open, the study included 14,053 participants – 7,491 were drinking any alcohol at baseline participants. Across all participants, 3395 (24.2%) had a decrease in alcohol use. Among 7491 participants with alcohol use at baseline, 3395 (45.3%) reported decreasing a category of alcohol use, 3923 (52.4%) reported no change, and 173 (2.3%) reported an increase.
Individuals receiving bupropion and naltrexone had a greater likelihood of reporting decreases in alcohol use compared with metformin, although this was no longer significant after controlling for weight loss (p=0.10).
They added that future research would benefit from a randomised trial comparing AOMs with a placebo-controlled or nonpharmacological weight management group.
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Economic Impact of Bariatric Surgery in Australia: 16-Year Results from the 45 and Up Study with Linked Health Data
The economic value of bariatric surgery lies in the long-term benefits, particularly when considering indirect costs, according to researchers form the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
The study, published in Obesity Surgery, sought to evaluate the economic impacts of bariatric surgery in a large cohort of Australians aged ≥45 years and included BMS patients (n=1,157) and non-surgical patients (n=1,157). Linear mixed-effects regression predicted the cost trajectory eight years pre- and post-bariatric surgery, and the difference-in-differences approach evaluated its economic impact.
They reported that direct healthcare costs increased over time in both groups - costs for the operated group peaked ($15,884) during the surgery year and became up to 23.8% lower than those for the non-operated group from the second year post-surgery when including indirect costs.
In addition, surgery’s economic benefits increased over longer horizons, with a maximum annual cost-saving of $3,196 per person in the eighth post-surgery year. However, they noted that even after accounting for indirect costs - cumulative cost-savings were not achieved. Subgroup analysis revealed sleeve gastrectomy as the least costly surgical option.
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Cephalopod-inspired jetting devices for gastrointestinal drug delivery
Massachusetts Institute of Technology (MIT) and Novo Nordisk researchers have developed an ingestible capsule that releases a burst of drugs directly into the wall of the stomach or other organs of the gastrointestinal tract.
The researchers wanted to explore ways to deliver therapeutic molecules to treat diabetes, obesity and other metabolic disorders without any kind of needle, which could reduce the possibility of any damage to the tissue.
To achieve that, they took inspiration from cephalopods. Squids and octopuses can propel themselves by filling their mantle cavity with water, then rapidly expelling it through their siphon. The researchers came up with two ways to mimic this jetting action, using compressed carbon dioxide or tightly coiled springs to generate the force needed to propel liquid drugs out of the capsule.
In a series of experiments using tissue from the digestive tract, the researchers calculated the pressures needed to expel the drugs with enough force that they would penetrate the submucosal tissue and accumulate there, creating a depot that would then release drugs into the tissue.
The researchers envision that the ingestible capsule could be used at home by patients who need to take insulin or other injected drugs frequently. In addition to making it easier to administer drugs, especially for patients who don't like needles, this approach also eliminates the need to dispose of sharp needles.
This capsule could offer an alternative way to deliver drugs that normally have to be injected, such as insulin and other large proteins, including antibodies. This needle-free strategy could also be used to deliver RNA, either as a vaccine or a therapeutic molecule to treat diabetes, obesity and other metabolic disorders.
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