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Journal Watch 02/11/2022

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 American Gastroenterological Association clinical guidelines on pharmacological interventions for adults with obesity, a study comparing Single Anastomosis Gastric Bypass and Roux-en-Y Gastric Bypass from MBSAQIP, bariatric surgery revisions and emergencies outcomes from MBSAQIP-accredited centres and unaccredited institutions, the association of weight loss following bariatric surgery with self-reported sleep quality one-year after surgery and T2DM remission post-RYGB, -SG and -OAGB (please note, log-in maybe required to access the full paper).

AGA Clinical Practice Guideline on Pharmacological Interventions for Adults With Obesity

The American Gastroenterological Association has published clinical guidelines on pharmacological interventions for adults with obesity and concluded that adults with overweight and obesity who have an inadequate response to lifestyle interventions alone, long-term pharmacological therapy is recommended, with multiple effective and safe treatment options.

Writing on behalf of the American Gastroenterological Association Clinical Guidelines Committee, the authors sated that the guidelines, published in Gastroenterology, are intended to support practitioners in decisions about pharmacological interventions for overweight and obesity.

A multidisciplinary panel of experts identified patient-centred outcomes from semaglutide 2.4mg, liraglutide 3.0mg, phentermine-topiramate extended-release (ER), naltrexone-bupropion ER, orlistat, phentermine, diethylpropion,and Gelesis100 oral superabsorbent hydrogel.

The guideline panel made nine recommendations, including strongly recommending the use of pharmacotherapy in addition to lifestyle intervention in adults with overweight and obesity (body mass index ≥30 kg/m2, or ≥27 kg/m2 with weight-related complications) who have an inadequate response to lifestyle interventions.

The panel suggested the use of semaglutide 2.4mg, liraglutide 3.0mg, phentermine-topiramate ER, and naltrexone-bupropion ER (based on moderate certainty evidence), and phentermine and diethylpropion (based on low certainty evidence), for long-term management of overweight and obesity. The guideline panel suggested against the use of orlistat. The panel identified the use of Gelesis100 oral superabsorbent hydrogel as a knowledge gap.

To access this paper, please click here

Comparing Patient Selection and 30-day Outcomes Between Single Anastomosis Gastric Bypass and Roux-en-Y Gastric Bypass: a Retrospective Cohort Study of 47,384 Patients

Investigators from the University of Alberta, Edmonton, Alberta, Canada, have found that patients undergoing Single Anastomosis Gastric Bypass (SAGB) were younger with marginally higher BMI, compared to Roux-en-Y Gastric Bypass (RYGB) and after adjusting for comorbidities, SAGB was associated with decreased odds of serious complications.

Writing in Obesity Surgery, they analysed data from the 2020 Metabolic and Bariatric Accreditation and Quality Improvement Program (MBSAQIP) was comparing SAGB to RYGB. Bivariate analysis and multivariable logistic regression models compared difference between groups and factors associated with 30-day serious complications and mortality.

In total, 47,384 patients were evaluated - 1,344 (2.8%) undergoing SAGB. SAGB patients had a higher BMI (45.2 ± 7.6 kg/m2 vs 44.6 ± 7.9 kg/m2, p=0.006) and younger age (44.3 ± 12.1 years vs. 45.4 ± 11.5 years, p=0.0008) than RYGB patients respectively. SAGB patients were less likely to have GERD (42.6% SAGB vs. 45.7% RYGB, p=0.02), sleep apnoea (37.8% SAGB vs. 41.1% RYGB, p=0.02), and chronic steroid use (1.3% SAGB vs. 2.2% RYGB, p=0.04). There were no significant difference in diabetes, hypertension or dyslipidaemia rates.

SAGB was independently associated with decreased serious complications (4.7% vs. 8.4%, p<0.0001) within 30 days compared to RYGB. And were also less likely to experience reoperation (1.6% vs. 2.6%, p=0.03) and readmission (2.2 vs. 5.8%, p<0.0001).

They concluded that ongoing prospective studies analysing long-term outcomes following SAGB are required.

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Predictors of morbidity in revisional bariatric surgery and bariatric emergencies at an MBSAQIP-accredited community hospital

An international team of researchers, writing in the World Journal of Emergency Surgery, have reported that bariatric surgery revisions and emergencies in community hospital MBSAQIP-accredited centres have comparable outcomes to those reported by urban academic centres.

The authors conducted a retrospective review on 53 bariatric surgery revisions and 61 bariatric surgical emergencies by a single surgeon at a high-volume community hospital accredited program from 2018 to 2020. Primary outcomes were complications or deaths occurring within 30-days of the index procedure. Secondary outcomes included operative time, leaks, surgical site occurrences (SSOs) and deep surgical site infections.

They found that there were no significant differences in the demographic characteristics of the study groups. Mean operative time was significantly longer for revisions vs. emergency operations (149.5 vs. 89.4 min). Emergencies had higher surgical site infection (5.7% vs. 21.3%, p<0.05) and surgical site occurrence (SSO) (1.9% vs. 29.5%, p<0.05) rates vs. revisions. Logistic regression analysis identified several factors to be predictive of increased risk of morbidity: pre-operative albumin <3.5 g/dL (p<0.05), recent bariatric procedure within the last 30 days (p<0.05), prior revisional bariatric surgery (p<0.05), prior duodenal switch (p<0.05) and pre-operative COPD (p<0.05).

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The association of 1-year weight loss from bariatric surgery and self-reported sleep: a prospective cohort

Researchers from Kaiser Permanente Southern California, Pasadena, CA, have reported that weight loss from bariatric surgery was associated with better self-reported sleep at one year, indicating that bariatric surgery may have an added benefit of better sleep.

Writing in Obesity journal, they examined the association of weight loss following bariatric surgery with self-reported sleep quality after accounting for other sleep-related factors, from the Bariatric Experience Long Term (BELONG) study. Participants completed a survey up to six months before surgery and approximately one-year after surgery.

From 997 participants in the analytic cohort, they reported that each 1% increase in %TWL was associated with a 3% better daytime dysfunction score (odds ratio = 1.03; 95% CI: 1.02-1.05) and a 2% better sleep quality score (odds ratio = 1.02; 95% CI: 1.00-1.03). There were no significant differences were found for the other Pittsburgh Sleep Quality Index (PSQI) components.

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Type 2 diabetes remission after Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and one anastomosis gastric bypass (OAGB): results of the longitudinal assessment of bariatric surgery study

An international team of researchers have reported that remission of T2DM after RYGB, SG, and OAGB surgery is dependent on various preoperative factors.

Writing in BMC Endocrine Disorders, they sought to identify the T2DM remission rate and to determine the effects of preoperative factors characteristics of remission T2DM in Iran. In total, 1,351 patients (675 (50.0%) OAGB, 475 (35.2%) RYGB and 201 (14.9%) SG), were included in the study.

They reported that 80.6%, 84.2% of OAGB patients, 81.7%, 82.6% of RYGB patients and 77.1%, 81.5% of SG patients were in T2DM remission after one and three years, respectively. Remission were associated with preoperative age, duration of T2DM, FBS and HbA1c, BMI, insulin therapy and a family history of obesity (p<0.05).

“Patients with younger age, shorter duration of T2DM, lower preoperative HbA1c and FBS, higher BMI, who were not on insulin therapy, and not having a family history of obesity were the best candidates to achieve a prolonged diabetes remission,” they concluded.

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