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 an IFSO Position Statement on ESG, ten-year Teen-LABS outcomes, SASI safe and effective for T2DM management, homocysteine levels after bariatric metabolic surgery and a systematic review of cost-effectiveness and economic burden of GERD, and more (please note, log-in maybe required to access the full paper).
IFSO Bariatric Endoscopy Committee Evidence-Based Review and Position Statement on Endoscopic Sleeve Gastroplasty for Obesity Management
A comprehensive systematic review conducted by the IFSO Bariatric Endoscopy Committee has reported that endoscopic sleeve gastroplasty (ESG) results in significant weight loss and therefore endorses the procedure as an effective and valuable treatment for obesity.
Reporting in Obesity Surgery, the IFSO Bariatric Endoscopy Committee conducted a comprehensive systematic review including 44 articles encompassing 15,714 patients receiving ESG from large case series to cohort studies and a randomised controlled trial (RCT).
They reported that ESG is particularly beneficial for patients with class I and II obesity, as well as for those with class III obesity who are not suitable candidates for metabolic bariatric surgery. The procedure also has a favourable safety profile with pooled serious adverse event (SAE) rate of 1.25%.
Despite the limitations of the included observational studies, the randomised controlled trial included in the analysis reinforces the efficacy and safety of ESG and provides an evidence-based foundation for the position statement.
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Ten-Year Outcomes after Bariatric Surgery in Adolescents
Ten years after undergoing bariatric surgery as adolescents, over half of participants in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS), demonstrated not only sustained weight loss, but also resolution of obesity-related conditions, such as type 2 diabetes, high blood pressure and high cholesterol, according to a report published in the New England Journal of Medicine.
Teen-LABS investigators analysed outcomes of 260 patients at ten years after bariatric surgery as teenagers (13–19 years of age). They found that the body mass index (BMI) declined by 20%. Importantly, the study found that 55% of the participants who had type 2 diabetes as teenagers and underwent surgery were still in remission of their diabetes at ten years.
This study documents the long-term durability of weight loss and remission of related conditions after bariatric surgery, as well as the greater health benefits in adolescents than would be expected in similarly treated adults, the researchers concluded.
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Efficacy of single anastomosis sleeve-ileal bypass in weight control and resolution of type 2 diabetes mellitus – a retrospective cohort study
Single Anastomosis Sleeve-Ileal Bypass (SASI) is an effective and safe procedure for treating T2DM, resulting in significant weight loss and metabolic improvements over a one-year follow-up, and seems to be a favourable option for T2DM management in metabolic bariatric surgery, according to researchers from Orłowski Hospital, Warsaw, Poland.
Writing in Scientific Reports, the retrospective cohort study analysed 31 patients with obesity and T2DM who underwent SASI. At one year follow-up, the mean %EWL was 85.6% and %TWL was 31.7%. T2DM remission was achieved in 24 (77.4%) patients, improvement in 4 (12.9%) and no change in 3 (9.7%). Hypertension improved in 21 (87.5%) patients, with 12 (50%) achieving remission. Significant reductions in BMI and HbA1c levels were observed (p<0.001).
Responders and non-responders groups showed significant differences in postoperative BMI and %EWL (p=0.007, p=0.023), with one patient experiencing a Clavien-Dindo Grade III complication.
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Investigation of homocysteine level after bariatric metabolic surgery, effect on vitamin B12 and folate levels
The relationship between Vitamin B12, folate and homocysteine is important in order to better understand the complications that develop in bariatric metabolic surgery patients, to prevent possible complications and to better manage the process, according to Turkish researchers.
Reporting in BMC Endocrine Disorders, they examine the relationship between Vitamin B12, Folic acid and homocysteine in 126 patients who underwent bariatric metabolic surgery between September 2019 and September 2020. Patients with the desired biochemical parameters at the determined follow-up points were identified and two groups were formed as RYGB (n=43) and SG (n=7) patients.
When biochemical parameters were analysed between the groups, homocysteine, HbA1c, HDL Cholesterol, VLDL Cholesterol, Total Cholesterol, Triglycerides, Ferritin and Serum Iron levels showed a statistical difference (p<0.001). Folate (p=0.064) and albumin (p=0.257) did not show a significant difference over time. The change in vitamin B12 (p=0.409) over time was not significant in the SG group, whereas a significant difference was observed in the RYGB group (p<0.001).
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Diagnosis and treatment of patients with gastroesophageal reflux disease – a systematic review of cost-effectiveness and economic burden
Advances in emerging technologies for diagnostics and screening of GERDmay lead to a shift in the entire treatment model, offering less invasive options and potentially improving patients’ quality of life, according to investigators from the University of Hradec Kralove, Hradec, Poland.
Writing in BMC Health Services Research, the study reviewed 36 studies and the existing knowledge on the cost-effectiveness, item costs related to the diagnosis and the treatment of GERD patients at different stages.
Regarding the cost-effectiveness of GERD treatment, Proton pump inhibitors (PPIs) appeared to be the dominant solution for non-refractory patients. However, this might change with the adoption of the novel drug vonoprazan, the researcher noted, which is more effective and cheaper. With advancements in emerging technologies, new diagnostic and screening approaches such as Endosheath, Cytosponge, and combined multichannel intraluminal impedance and pH monitoring catheters should be considered, with potential implications for optimal GERD management strategies.
Surgery, such as magnetic sphincter augmentation or laparoscopic fundoplication, is only recommended for patients with treatment-resistant GERD or severe symptoms.
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