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 ten-year BPD-DS vs RYGB outcomes, OAGB vs RYGB, ESG for BMI 70, mild differences in gastric emptying among patients taking GLP-1s, complications after laparoscopic revisional/conversional revisional VSG and concurrent hiatal hernia repair, and more (please note, log-in maybe required to access the full paper).
Ten-Year Outcomes Following Roux-en-Y Gastric Bypass vs Duodenal Switch for High Body Mass Index - A Randomized Clinical Trial
BMI reduction was greater after Duodenal Switch (DS), but Roux-en-Y-gastric bypass (RYGB) had a better risk profile over ten years, according to the ten-year outcomes from the ASGARD Trial by researchers from Norway and Sweden.
Writing in JAMA Network Open, the researchers compared weight loss, health outcomes and quality of life ten years or more after either procedure. Forty-eight of the original 60 patients (80%) were assessed after a median of 12 (range, 9-13) years.
At follow-up, the mean BMI reductions were 11.0 for RYGB and 20.3 for DS, with a mean between-group difference of 9.3 (95% CI, 5.4-13.1; p<0.001). Total weight loss was 20.0% (95% CI, 15.3%-24.7%) for RYGB and 33.9% (95% CI, 27.8%-40.0%) for DS (p=0.001).
More patients in the DS group developed vitamin deficiencies (21 vs 11 for RYGB; p=0.008) including 25-hydroxyvitamin D deficiency (19 for DS vs 9 for RYGB; p=0.005). Four of 29 patients in the DS group (14%) developed severe protein-caloric malnutrition, three (10%) underwent revisional surgery.
They concluded that biliopancreatic diversion with DS may not be a better surgical strategy than RYGB for patients with a BMI of 50-60.
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Laparoscopic Roux-Y-gastric bypass versus laparoscopic one-anastomosis gastric bypass for obesity: clinical & metabolic results of a prospective randomized controlled trial
At one-year, percent excess weight loss was higher in patients after one anastomosis gastric bypass (OAGB) compared to Roux-en-Y gastric bypass (RYGB), researchers from University of Zurich, Zurich, Switzerland, have reported.
Writing in Surgical Endoscopy, they performed a non-inferiority randomised controlled trial in 80 patients (40 in each group) to assess the effectiveness and safety of these 2 operative techniques.
Mean %EWL at 12 months was 87.9% (SD24.4) in the RYGB group and 104.1% (SD24.6) in the OAGB group (p=0.006). The rate of marginal ulcers was higher in patients with OAGB compared to those with RYGB (p=0.011), while there was no statistical difference in the total number of late complications between the two groups. Except for the remission of GERD, which was higher in the RYGB group compared to OAGB, there was no difference between the groups regarding the remission of comorbidities.
In addition, there was better glycaemic control with a higher increase in GLP-1 observed after OAGB compared to RYGB.
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Early Safety of Endoscopic Sleeve Gastroplasty in Super Obesity (BMI > 50)
Endoscopic sleeve gastroplasty (ESG) may be performed safely, with comparable safety to sleeve gastroplasty in patients with BMI as high as 70, according to a study lead by researchers from the University of Virginia, Charlottesville, VA.
Reporting in SOARD, they evaluate the short-term safety profile of ESG in patients with super obesity using data from the MBSAQIP database. They found there were no significant differences in adverse events (AEs), reoperations, hospital readmissions or reinterventions for patients with super obesity undergoing ESG, compared to patients with BMI below 50. Mean TBWL was greater in patients with super obesity. There were no significant differences in AEs for patients with super obesity who underwent ESG vs SG, although ESG patients had more hospital readmissions, reinterventions and reoperations.
However, they cautioned that further studies are needed to validate the feasibility and long-term efficacy prior to clinical implementation.
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Quantified Metrics of Gastric Emptying Delay by Glucagon-Like Peptide-1 Agonists: A Systematic Review and Meta-Analysis With Insights for Periprocedural Management
There are only mild differences in gastric emptying among patients taking glucagon-like peptide-1 (GLP-1) receptor agonist medications for type 2 diabetes and weight loss, according to a meta-analysis and review of 15 randomised studies by researchers from Brigham and Women’s Hospital.
Writing in the American Journal of Gastroenterology, five studies (n=247) utilized gastric emptying scintigraphy. Mean T1/2 was 138.4 minutes (95% CI 74.5–202.3) for GLP-1 RA vs 95.0 minutes (95% CI 54.9–135.0) for placebo, with a pooled mean difference of 36.0 minutes (95% CI 17.0–55.0, p<0.01, I2 = 79.4%). Ten studies (n=411) utilized the acetaminophen absorption test, with no significant delay in gastric emptying measured by Tmax, area under the curve (AUC)4hr, and AUC5hr with GLP-1 RA (p>0.05). On meta-regression, the type of GLP-1 RA, mechanism of action, and treatment duration did not impact gastric emptying (p>0.05).
While a gastric emptying delay of ∼36 minutes is quantifiable on GLP-1 RA medications, it is of limited magnitude relative to standard periprocedural fasting periods, they concluded.
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Propensity score matched analysis of laparoscopic revisional and conversional sleeve gastrectomy with concurrent hiatal hernia repair
Despite a small association with increased postoperative pneumonia, the rate of complications in patients undergoing laparoscopic revisional/conversional revisional vertical sleeve gastrectomy (VSG) and concurrent hiatal hernia repair (CHHR) are low, according to researchers from University of Missouri School of Medicine, Columbia, MO.
Reporting in Surgical Endoscopy, they evaluate outcomes associated with CHHR when performing a conversional or revisional VSG, using data from the MBSAQIP. There were 33,909 patients available, with 5,986 undergoing the VSG procedure with CHHR. In the unmatched analysis, there was an increased frequency of patients being female (85.72 vs 83.30%; p<0.001), having a history of GERD (38.01 vs 31.25%; p<0.001), and being of older age (49.59 ± 10.97 vs 48.70 ± 10.83; p<0.001). Patients undergoing VSG with CHHR experienced decreased sleep apnoea (25.00 vs 28.84%; p<0.001) and diabetes (14.27 vs 17.80%; p<0.001).
Matched patients with CHHR experienced increased operative time (115 min ± 53 vs 103 min ± 51; p<0.001), increased risk of postoperative pneumonia (0.45 vs 0.15%; p=0.005) and readmission (4.69 vs 3.58%; p=0.002) within thirty days. However, patients undergoing CHHR with revisional or conversional VSG did not experience increased risk of death, postoperative bleeding, postoperative leak or reoperations.
They investigators concluded that CHHR is a safe option when combined with the laparoscopic revisional/conversional VSG procedure in the early postoperative period.
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