Journal Watch 9/4/2025

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 survival and cost-effectiveness of BMS in patients with obesity and cirrhosis, ESG is an effective modality for the treatment of comorbid T2DM and MetS, EUS-GJ is an excellent modality for the palliation of mGOO, DJBS plus intensive lifestyle intervention was not cost-effective and remote follow-up via a mobile application holds promise for enhancing the management of BMS patients and more (please note, log-in maybe required to access the full paper).

Survival and Cost-Effectiveness of Bariatric Surgery Among Patients With Obesity and Cirrhosis

US researchers have reported bariatric surgery was associated with improved survival and expected weight loss and was cost-effective, and supports the expanded use of bariatric surgery in appropriately selected patients, including those with cirrhosis, to improve outcomes and reduce long-term health care costs.

Writing in JAMA Surgery, the analysis included 4301 SG, 1906 RYGB, and 31 055 non-surgical controls, among whom 64, 8, and 354, respectively, had cirrhosis. Compared with non-surgical controls, bariatric surgery was associated with longer observed survival (9.67 years vs 9.46 years overall; 9.09 years vs 8.23 years in cirrhosis). The ICER was $132,207 for SG and $159,027 for RYGB in the overall cohort, and $18,679 for SG and $44,704 for RYGB in the cirrhosis cohorts.

Overall, bariatric surgery was cost-effective at a willingness-to-pay threshold of $100,000 per quality-adjusted life-year among patients with cirrhosis.

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Endoscopic Sleeve Gastroplasty for the Treatment of Metabolic Syndrome: A Systematic Review and Meta-analysis

Endoscopic sleeve gastroplasty (ESG) is an effective modality for the treatment of comorbid T2DM and MetS in patients with obesity, according to US researchers.

Reporting in Obesity Surgery, their analysis included ten studies with 4320 patients. At 12 months, ESG was associated with significant improvements in T2DM, HLD, and HTN, with risk difference of − 0.72 [95% CI, − 0.87 to − 0.58, p < 0.00001], − 0.65 [95% CI, − 0.78 to − 0.52, p < 0.00001], and − 0.60 [95% CI, − 0.66 to − 0.53, p < 0.00001], respectively.

Additionally, there were significant reductions in haemoglobin A1c (HGBA1c), fasting blood glucose, homeostatic model assessment for insulin resistance (HOMA-IR), low-density lipoprotein, and triglycerides.

Additional studies are needed to establish long-term responses and to compare ESG against established pharmacologic and surgical techniques, the researchers concluded.

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Endoscopic Ultrasound–Guided Gastrojejunostomy as a Primary Treatment Modality for Malignant Gastric Outlet Obstruction: A Large Multicenter Experience

Endoscopic ultrasound–guided gastrojejunostomy (EUS-GJ) is an excellent modality for the palliation of malignant gastric outlet obstruction (mGOO), providing high clinical success with extremely low rates of reintervention and acceptable safety profile, according to researchers from India.

Reporting in the Journal of Gastroenterology and Hepatology, a total of 71 patients underwent EUS-GJ with technical success of 94.3%. After successful stent placement, all patients tolerated oral liquid diet on day 1, whereas 89.5% and 95.5% tolerated oral solid diet on day 2 and day 7, respectively. Overall, 9/71(12.6%) patients had major adverse events, which included maldeployment in 6/71(8.4%). Mean duration of follow-up was 76.13 ± 58.09 days.

On follow-up, reintervention was required in two (3%) patients. Around two-thirds of patients gained weight and could resume their chemotherapy post-EUS-GJ. Kaplan–Meier survival analysis showed that post EUS-GJ, mean overall survival (symptom recurrence or death) of 144.39 ± 11.53 days (95% CI 121.7–167.0).

The authors concluded that EUS-GJ should be considered as a primary modality for managing these patients, and enteral stent should be reserved for patients where EUS-GJ is not possible.

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Cost-effectiveness analysis of duodenal–jejunal bypass sleeve device for people with obesity

Chinese researchers have reported duodenal–Jejunal Bypass Sleeve (DJBS) plus Intensive Lifestyle Intervention (ILI) was not a cost-effective strategy over a lifetime horizon when the WTP threshold was set at GDP per capita and disposable income per capita

The researchers used a hybrid model using a Decision Tree and Markov model was used to compare 9-month and lifetime horizon cost-effectiveness between DJBS plus ILI and ILI only. The data on clinical effectiveness were based on a prospective, open-label, and randomized trial.

The results of the 9-month decision tree model showed that compared to ILI only, DJBS plus ILI decreased body mass index (BMI) by 1.69 kg/m2 (1.41 vs. 3.10), with an increasing cost of ¥28,963.98 yuan (¥29,111.06 vs.¥147.08). The incremental cost-effectiveness ratio (ICER) was ¥17,138.45 per unit decrease of BMI. The lifetime horizon model showed that compared to ILI only, DJBS plus ILI had a higher cost of ¥13261.94 yuan (¥31,688.98 vs. ¥18,427.04), while with a life-year increase of 0.02 (9.43 vs. 9.41) and quality-adjusted life years (QALYs) increase of 0.15 (7.82 vs. 7.67) per people with obesity. The ICER was ¥88,412.93 per QALY gained. Probability sensitivity analysis showed the robustness of the economic evaluation results.

However, it was considered cost-effective when the threshold was set at 1.03 times GDP per capita.

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Feasibility and satisfaction with remote digital postoperative follow-up using a three-tiered alert system after bariatric surgery

Researchers from Belgium have found that remote follow-up via a mobile application holds promise for enhancing the management of bariatric surgery patients, complementing traditional practices.

Writing in the International Journal of Obesity, they sought to evaluate the safety and feasibility of responsive remote digital postoperative follow-up using a smartphone application.

During the study period, a total of 1,119 alerts were recorded from 104 patients, with 39.3% occurring within the first seven postoperative days. Patient alert profiles were significantly associated with postoperative outcomes, with worsening outcomes observed from basic orange alerts to red+ alerts. Patients with red+ alerts had nearly a threefold increase in postoperative morbidity rates, emergency department visits, and readmissions. There were n significant differences in weight loss outcomes were observed. Patient response adherence was 67.5%, while the overall satisfaction with the use of the application was 94%.

The implementation of a three-tiered alert system may help identify patients at risk of serious complications, potentially reducing unnecessary emergency department and hospital resource utilisation, the researchers concluded.

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