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 pancreatic enzyme replacement plus surgery and vitamin D, gastric bypass best procedure for improving cardiac structure, outcomes from SG conversion to BPD-DS, SADI and RYGB, DUCATI trial outcomes, weight loss injections could increase the risk of depression and BariClip outcomes, and more (please note, log-in maybe required to access the full paper).
Pancreatic Enzyme Replacement Leads to Increased Vitamin D Uptake in Patients Undergoing Sleeve-gastrectomy — A Prospective, Monocentric Trial
There is an association between pancreatic enzyme replacement (PERT) and higher vitamin D levels in patients undergoing metabolic and bariatric surgery (MBS), according to a study led by researchers from the Klinikum Siegen, Siegen, Germany.
Writing in Obesity Surgery, they designed a prospective two-arm randomised controlled trial on patients who underwent either sleeve gastrectomy or gastric bypass. Patients were randomised to the treatment group with PERT or to the control group.
In total, 204 patients were enrolled with 139 completing follow-up. The outcomes indicated that PERT does not lead to slower weight loss or BMI reduction and there were significantly better vitamin D levels in patients undergoing MBS and PERT. No statistical difference was seen regarding albumin.
“An optimised enzymatic environment due to PERT may therefore result in higher vitamin D levels and may improve clinical outcomes in patients undergoing MBS,” they conclude.
To access this paper, please click here
Bariatric surgeries and cardiac structure and function: Systematic review and network meta-analysis
A meta-analysis by Chinese researchers has indicated that gastric bypass is the best procedure for improving the cardiac structure however, there was no obvious improvement in cardiac function for all bariatric surgeries.
Reporting in Obesity Reviews, their systematic review and network meta-analysis included 19 studies (17 cohort studies and 2 randomized controlled trials) and 2012 adults. They found patients undergoing gastric bypass had appreciably lowered LVM (p< 0.01) and LVMI (p<0.01) compared with other bariatric surgeries. They reported no significant improvement in LVEF across all surgeries. The drop in body mass index was most pronounced for biliopancreatic diversion with duodenal switch (p<0.01).
The concluded that additional studies are required to better understand the differing effectiveness of bariatric surgeries on cardiac structure and function, and the underlying molecular mechanisms.
To access this paper, please click here
National trends in utilizing revisional surgeries post-sleeve gastrectomy due to reflux and weight recurrence: A matched case-control analysis
For weight recurrence after sleeve gastrectomy (SG), conversion to biliopancreatic diversion with duodenal switch (BPD-DS) and single-anastomosis duodenoileostomy (SADI) does not have higher 30-day complications than RYGB and may be a safe conversion option, according to study authors from Brigham and Women’s Hospital, Boston, MA.
Published in SOARD, they sought to determine and compare 30-day risk profiles of SG conversion to RYGB, BPD-DS and SADI. Using the MBSAQIP database from 2020-2022 some 25,760 adult patients who underwent SG conversion to RYGB, BPD-DS, or SADI were identified. Subgroup analyses were performed among 6,106 conversions completed for weight-related complications (RYGB 3,053 patients; BPD-DS 1,826 patients; SADI 1,227 patients).
RYGB conversions had a lower preoperative BMI compared to BPD-DS+SADI conversions (39.8 versus 46.1, p<0.001) and significantly lower rates of medical comorbidities. Most RYGB conversions were for reflux (56.1%) while most BPD-DS+SADI conversions were for weight-related complications (87.3%; p<0.001). Odds of 30-day complications (p=0.019) and readmission (p=0.031) were lower in BPD-DS+SADI conversions compared to RYGB. However, there were no significant differences in odds of 30-day reintervention or reoperation between conversion to RYGB and BPD-DS+SADI. Major differing drivers of complications between conversion types included haemorrhage (RYGB 1.98% versus BPD-DS+SADI 0.87%; p=0.001).
To access this paper, please click here
Long-term Outcome of the Dutch Common Channel Trial (DUCATI): Preservation of Superior Weight Loss Results Without Significant Malnutrition Side Effects
A 100cm common channel with a relatively long Roux limb provides superior, sustainable weight loss over five years, without significantly increased rate of malabsorption-related re-operations, researchers from the Netherlands have concluded.
Reporting in Obesity Surgery, the multi-centre Dutch Common Channel Trial (DUCATI) compared the outcomes of a very long Roux Limb Roux-en-Y gastric bypass (VLRL-LRYGB) with a standard Roux-en-Y gastric bypass (S-LRYGB). 222 patients were randomised to each group and five-year follow-up data were assessed, concentrating on weight loss, obesity-related medical conditions, complications, re-operations, and malnutrition.
Both groups had comparable total alimentary lengths (RL + CC). The VLRL-LRYGB group demonstrated significantly greater %TWL (32.2% vs. 28.6%, p=0.002) and %EWL (81.2% vs. 70.3%, p = 0.002) at five years. Eight (3.6%) patients in the VLRL-LRYGB group versus 2 (0.9%) in the S-LRYGB group (p = 0.055) needed modification surgery for malabsorption. Suboptimal clinical response rate was significantly higher (22.0% vs. 8.3%) in S-LRYGB group. No significant differences for nutrient deficiencies in favour of the S-LRYGB group were found.
“These results suggest that a longer Roux limb can still ensure adequate micronutrient uptake in the total alimentary tract,” they concluded. “These findings should be considered in discussions regarding the optimal Roux-en-Y limb length for severe obesity treatment.”
To access this paper, please click here
Psychological changes among weight loss injection users compared with bariatric surgery patients in Saudi Arabia
Weight loss treatment by injections could increase the risk of depression with nearly one-quarter of the study population experiencing anxiety or depression following weight loss treatment, Saudi Arabian researchers report in the Neurosciences Journal.
The researchers assessed and evaluated the mental health and psychological changes in weight loss injection users and bariatric surgery in 721 patients (73.9% were females and 30.1% were aged between 30 to 39 years old). The prevalence of patients who underwent weight loss by surgery and injection was 47.7% and 41.2%, respectively.
The researchers reported symptoms of anxiety and depression were detected in 19.7% and 24%, respectively. Independent risk factor of anxiety and depression was the symptom of the psychiatric disorder prior to surgery, while the independent protective factor for anxiety and depression was older age. Depression was higher in weight loss injection users.
The study authors called for appropriate psychiatric evaluation is before and after weight loss intervention.
To access this paper, please click here
BariClip: Outcomes and Complications from a Single-Center Experience
Laparoscopic BariClip gastroplasty (LBCG) remains an experimental procedure that must be approached with caution, Italian researcher have reported. However, the potential of LBCG to reproduce the effects of LSG - while reducing GERD - makes it a promising new reversible option for the treatment of morbid obesity.
The study authors from Policlinico San Marco, Bergamo, Italy, writing in Obesity Surgery, analysed data from 149 patients who underwent LBCG procedure between July 2021 and November 2023 (minimum follow-up period of 6 months was observed for all patients). The collected clinically relevant GERD through GERD-Q score questionnaires, weight loss (via BMI) and % total weight loss (%TWL).
The overall complication rate was 8% (12/149) and the average BMI went from 40±4.37 kg/m2 to 28±4.29 kg/m2 (p<0.05) in six months, while the mean %TWL was 22.6% after at least six months of follow-up. Clinically relevant GERD went from 18.1% (27/149) to 10.7% (16/149), p=0.1262, but PPI usage was not altered significantly (17.8% vs 16.4%, p=0.8714).
To access this paper, please click here
Comments