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Journal Watch 02/02/2022

Welcome to our weekly round-up of the latest bariatric and obesity-related papers published in the medical literature. 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 a study comparing RYGB vs SG outcomes in young adults, pregnancy outcomes after bariatric surgery, an analysis of reported complications from the MBSAQIP and NSQIP databases, the outcomes on the cost-effectiveness of responsive deep brain stimulation (rDBS) compared with laparoscopic Roux-en-Y gastric bypass (LRYGB) and a study looking at the gut microbiota in severe chronic heart failure (CHF) patients (please note, log-in maybe required to access the full paper).

Roux-en-Y Gastric Bypass Versus Sleeve Gastrectomy in Young Adults: a Dutch Registry Study

Researchers from the Netherlands have reported that Roux-en-Y gastric bypass (RYGB) was associated with greater weight loss in young adults in the short- and midterm, particularly in females, compared to sleeve gastrectomy (SG).

Writing in Obesity Surgery, the study included young adults, aged 18–25 years, who underwent RYGB or SG between 2015 and 2019, with data from the Dutch Audit Treatment of Obesity (DATO). The primary outcome was weight loss expressed as percentage total weight loss (%TWL) in a period of three years after surgery. Secondary outcomes were the incidence of complications (< 30 days) and progression of obesity-related comorbidities.

In total, 2,313 patients were included, 1246 in the RYGB group and 1067 in the SG group. Percentage TWL was significantly higher in the RYGB group compared to the SG group at one, two and three years after surgery (respectively 2.4%, 2.9%, and 3.3% higher, p<0.001). RYGB was associated with an on-average 2.75 higher %TWL compared to SG in females (p<0.001), although this was not seen in males (p=0.514).

However, no differences were found in the incidence of complications or the progression of obesity-related comorbidities except for gastroesophageal reflux disease (GERD). There was more improvement or resolution of GERD in the RYGB group (95.2% vs. 56.3%, p<0.001).

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Becoming pregnant within the first year after bariatric surgery adversely affects postoperative weight loss

Writing in SOARD, researchers from OLVG Hospital, Amsterdam, the Netherlands, suggest that pregnancy within 12 months after bariatric surgery negatively affects the long-term weight loss after surgery.

The study authors noted that most guidelines recommend women to wait at least 12 months after surgery before becoming pregnant. No previous studies have investigated if becoming pregnant in the first or second year after surgery affects weight loss. Therefore, the aim of the study was to assess if pregnancy within the first or second year after bariatric surgery affects weight loss up to five years after surgery. A linear mixed model was used to assess the effect of the time between conception and surgery in groups on percentage total weight loss (%TWL).

A total of 55 patients undergoing a primary bariatric procedure were included (47 had RYGB). The median time between surgery and estimated conception was 22 months (range 0-51). Women who became pregnant between 12 and 24 months (n=18) and women who became pregnant after 24 months (n=24) had significantly more weight %TWL (respectively p=0.020 and p=0.024) than women who became pregnant within 12 months after bariatric surgery (n=12).

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Does Accreditation Matter? An Analysis of Complications of Bariatric Cases Using the MBSAQIP and NSQIP Databases

Investigators from Texas comparing two large nationwide databases - the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) and the National Quality Improvement Program (NSQIP), have reported NSQIP reports higher rates of bariatric complications.

They evaluated the differences in rates of complications between both databases regarding Roux-en-Y gastric bypass (RYGB) and Sleeve gastrectomy (SG) from 2017 to 2019 using the procedure codes 43644 and 43775. Fifteen common complications were evaluated and propensity matched analyses (PMA) were performed to control for differences across databases.

In total, there were 483,361 cases reported in the MBSAQIP and 57,598 in the NSQIP. PMA matched 57,479 cases for each database. Seven complications were different with higher rates reported in NSQIP than in MBSAQIP: myocardial infarction (MI), sepsis, organ/space SSI occurrences, deep vein thrombosis (DVT), urinary tract infections (UTI), pulmonary embolism (PE), ventilator-bound greater than 48 hours, and pneumonia.

When adjusting for the procedure performed, SG in NSQIP had higher rates of organ space SSI, DVT, sepsis and death. RYGB in NSQIP had higher rates of organ/space SSI, ventilator-bound greater than 48 hours, UTI, MI, DVT and sepsis.

Published in SOARD, the authors noted that further studies are needed to confirm the reasons behind difference.

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Can responsive deep brain stimulation be a cost-effective treatment for severe obesity?

Researchers from the Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, have published the outcomes on the cost-effectiveness of responsive deep brain stimulation (rDBS) compared with laparoscopic Roux-en-Y gastric bypass (LRYGB).

They collected efficacy and safety data on LRYGB and safety data on rDBS for established indications through a literature search. The success threshold was defined as minimum BMI reduction. Treatment costs were calculated via Medicare national reimbursement data.

The outcomes revealed LRYGB had a mean BMI reduction of 13.75 kg/m2. Based on adverse events, LRYGB was a less-preferred health state (overall adverse event utility of 0.96 [0.02]) than rDBS (0.98 [0.01]), but LRYGB ($14,366 [$6,410]) had a significantly lower treatment cost than rDBS ($29,951 [$4,490]; p<0.0001).

Therefore, writing in the journal Obesity, the authors concluded that rDBS is cost-effective compared with LRYGB, the multiple models yielded a success threshold range of 13.7 to 15.2 kg/m2.

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Alterations of the Gut Microbiota in Patients With Severe Chronic Heart Failure

Researchers from China, writing in Frontiers in Microbiology, have examined the alterations and further directions of gut microbiota in severe chronic heart failure (CHF) patients.

They analysed faecal samples from 29 CHF patients diagnosed with NYHA Class III-IV and 30 healthy controls using bacterial 16S rRNA gene sequencing. They found many significant differences between the two groups:

  • phylum Firmicutes was found to be remarkably decreased in severe CHF patients, and the phylum Proteobacteria was the second most abundant phyla in severe CHF patients instead of phylum Bacteroides strangely

  • α diversity indices such as chao1, PD-whole-tree and Shannon indices were significantly decreased in the severe CHF versus the control group, as well as the notable difference in β-diversity between the two groups

  • a remarkable decrease in the abundance of the short-chain fatty acids (SCFA)-producing bacteria including genera Ruminococcaceae UCG-004, Ruminococcaceae UCG-002, Lachnospiraceae FCS020 group, Dialister and the increased abundance of the genera in Enterococcus and Enterococcaceae with an increased production of lactic acid.

They concluded that the alternation of the gut microbiota was presumably associated with the function including Cell cycle control, cell division, chromosome partitioning, Amino acid transport and metabolism and Carbohydrate transport and metabolism through SCFA pathway.

The study authors said the findings provide the direction and theoretical knowledge for the regulation of gut flora in the treatment of severe CHF.

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