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Journal Watch 01/11/2023

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 revisional surgery for GERD, beta-blocker (BB) use may not significantly affect weight loss 12 months after surgery, bariatric surgery improves advanced molecular profile of lipoproteins and a systematic review and meta-analysis of randomized controlled trials of tirzepatide, and more (please note, log-in maybe required to access the full paper).

Revisional bariatric surgery for gastroesophageal reflux disease: characterizing patient and procedural factors and 30-day outcomes for a retrospective cohort of 4412 patients

Researchers from the University of Alberta Hospital, Edmonton, Canada, have reported that patients who underwent sleeve gastrectomy (SG) as their initial procedure were the primary group who required revisional surgery for gastroesophageal reflux disease (GERD); most underwent revision via RYGB.

Writing in Surgical Endoscopy, they sought to characterise patients requiring revisional surgery for GERD to understand their perioperative risks and identify strategies to improve their outcomes.

Using data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) registry, they identified 4,412 patients required revisional surgery for GERD (24% of all conversion procedures).

In the majority of cases, patients underwent SG as their original surgery (n=3,535, 80.1%) and the revisional surgery for most patients was a Roux-en-Y gastric bypass (RYGB) (n=3,722, 84.4%). Multivariable analyses revealed that operative length, pre-operative antacid use and RYGB were predictors of major complications.

They concluded that further studies are needed to tailor operative approaches and pre-operative optimisation for revisional surgery patients.

To access this paper, please click here

Effect of beta-blocker therapy on weight loss outcomes after sleeve gastrectomy & Roux-en-Y gastric bypass

Investigators from Minnesota Medical School, Minneapolis, MN, have found that beta-blocker (BB) use may not significantly affect weight loss 12 months after bariatric surgery.

Reporting in SOARD, they assessed how BBs impacted 12-month weight loss in patients undergoing sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB).

We reviewed health records of 889 individuals (SG, n=485; RYGB, n=404) and found RYGB led to greater %TBWL compared to SG (31% versus 26%, p<0.01) and greater %EBMIL (79% versus 64%, p<0.01). BB status did not significantly affect 12-month %TBWL or %EBMIL.

“This finding could enable physicians to prescribe BBs for improved blood pressure control in bariatric surgery patients with less concern of blunting weight loss,” they concluded. “Longer term follow-up with a larger sample size would be an important next step to better characterise the relationship between BB usage and bariatric surgery.”

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Advanced Lipoproteins and Lipidomic Profile in Plasma Determined by Nuclear Magnetic Resonance Before and After Bariatric Surgery

Spanish researchers have found bariatric surgery improves advanced molecular profile of lipoproteins, decreasing cardiovascular risk factors (CVRF).

Reporting in Obesity Surgery, they sought to demonstrate the change in the advanced molecular profile of lipoproteins determined by nuclear magnetic resonance (NMR) spectroscopy in plasma after bariatric surgery, thus reducing the risk of cardiovascular disease. The advanced lipid profile was analysed in plasma from the immediate preoperative period and at the 18th postoperative month by sending samples and performing plasma magnetic resonance spectroscopy.

Fifty-two patients were included in the study, 29 (55.7%) underwent banded gastric bypass, 19.23% underwent bypass and 17.31% vertical gastrectomy. The rest were revision surgeries, two BPG-A and two biliopancreatic diversions after GV. All patients presented some improvement in advanced molecular profile of lipoproteins with 20% of the patients’ parameters normalised.

They concluded that analysis of the characteristics of lipoprotein particles by NMR spectrometry is optimal for studying lipoprotein metabolism in patients undergoing bariatric surgery.

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Efficacy and safety of tirzepatide, dual GLP-1/GIP receptor agonists, in the management of type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials

Researchers from Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China, have concluded Tirzepatide, a dual GIP/GLP-1 receptor co-agonist, for diabetes therapy has opened a new era on personalised glycemia control and weight loss in a safe manner with broad and promising clinical implications.

Writing in Diabetology & Metabolic Syndrome, the systematic review and meta-analysis of randomised controlled trials sought to report the primary efficacy and safety outcomes through clinically randomized controlled trials to evaluate integrated potency and signalling properties.

They found that participants treated with weekly Tirzepatide achieved HbA1c and body weight target values significantly lower than any other comparator without clinically significant increase in the incidence of hypoglycaemic events, serious and all-cause fatal adverse events. However, gastrointestinal adverse events and decreased appetite events were reported more frequently with Tirzepatide treatment than with placebo/controls.

To access this paper, please click here


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