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Journal Watch 08/06/2022

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 SPLENDID outcomes from a study comparing cancer rates for bariatric vs non-bariatric patients, revisional RYGB after failed LSG vs primary RYGB, depression in post-bariatric patients, results from the SURMOUNT-1 (Tirzepatide) randomised clinical trial and the positive impact of bariatric surgery on PCOS (please note, log-in maybe required to access the full paper).

Association of Bariatric Surgery With Cancer Risk and Mortality in Adults With Obesity

A research team led by the Cleveland Clinic have reported in JAMA that for adults with obesity, bariatric surgery vs no surgery is associated with a significantly lower incidence of obesity-associated cancer and cancer-related mortality.

In the SPLENDID (Surgical Procedures and Long-term Effectiveness in Neoplastic Disease Incidence and Death) study, adult patients with BMI>35 who underwent bariatric surgery were matched 1:5 to patients who did not undergo surgery for their obesity, resulting in a total of 30, 318 patients (n = 5,053 including Roux-en-Y gastric bypass and sleeve gastrectomy, vs nonsurgical care, n=25,265).

The mean between-group difference in body weight at ten years was 24.8kg or a 19.2% greater weight loss in the bariatric surgery group. During follow-up, 96 patients in the bariatric surgery group and 780 patients in the nonsurgical control group had an incident obesity-associated cancer. The cumulative incidence of the primary end point at ten years was 2.9% in the bariatric surgery group and 4.9% in the nonsurgical control group (p=0.002). The cumulative incidence of cancer-related mortality at ten years was 0.8% in the bariatric surgery group and 1.4% in the nonsurgical control group (p=0.01).

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Early postoperative complications after gastric bypass revisional surgery in patients with previous sleeve gastrectomy versus primary gastric bypass

Investigators from the Hospital General Universitario de Alicante, Spain, have reported there are no differences between primary RYGB RYGB-1) and revisional RYGB (RYGB-RS) after primary-sleeve gastrectomy (SG-1), in early morbidity, mortality, emergencies or readmissions.

Writing in SOARD, the team carried out their retrospective study that included 628 patients (48 RYGB-RS, 580 RYGB-1) were studied. Indications for revisional surgery were weight regain/insufficient weight loss (72.9%), weight regain/insufficient weight loss + gastroesophageal reflux disease (GERD) (14.6%) and GERD (12.5%). There were no differences in the frequency of complications (RYGB-RS, 22.9%, vs RYGB-1, 20.5%) or in their severity (RYGB-RS 10.4% vs RYGB-1, 6.4%, p>0.05). There were no differences in emergency room visits: RYGB-RS, 12.5% ​​vs RYGB-1, 14.9% or in readmissions: RYGB-RS, 12.5%​​ vs RYGB-1, 9.4%.

The authors concluded that revisional bariatric surgery is a safe procedure at referral centres and must be done by expert hands.

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Prevalence and Outcomes of Depression After Bariatric Surgery: A Systematic Review and Meta-Analysis

Investigators from Saudi Arabia have reported that post-bariatric surgery depression affects almost one in five patients and is associated with weight regain, eating disorders and quality of life.

In their meta-analysis (33 articles, 101,223 patients), published in Cureus, they reported that the prevalence of post-bariatric surgery depression was 15.3% (p<0.001) among which severe, moderate and minimal depression accounted for 1.9% (p<0.001), 5.1% (p<0.001) and 64.9% (p<0.001), respectively. Depression is negatively correlated with weight loss (correlation -0.135; 95% CI: -0.176 to 0.093; p<0.001) and positively correlated with eating disorder (correlation 0.164; 95% CI: 0.079-0.248; p<0.001).

“The integration of these findings in healthcare protocols can help healthcare providers identify patients at a higher risk of depression and enhance bariatric surgery outcomes by stratifying the patients to the most appropriate and effective treatment in a timely fashion” the authors concluded.

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Tirzepatide Once Weekly for the Treatment of Obesity

The first published outcomes from the SURMOUNT-1 randomised clinical trial, featured in the New England Journal of Medicine, have revealed that patients who receive once-weekly, subcutaneous tirzepatide (5mg, 10mg, or 15mg) had substantial and sustained reductions in body weight, compared to placebo.

In total, 2539 adults with a BMI>30 were randomised in a 1:1:1:1 ratio to receive once-weekly, subcutaneous tirzepatide (5mg, 10mg, or 15mg) or placebo for 72 weeks, including a 20-week dose-escalation period.

At week 72, the mean percentage change in weight −15.0% with 5-mg weekly doses of tirzepatide, −19.5% with 10-mg doses −20.9% with 15-mg doses and −3.1% with placebo (p<0.001 for all comparisons with placebo). The percentage of participants who had weight reduction of 5% or more was 85%, 89% and 91% (95% CI, 88 to 94) with 5 mg, 10 mg, and 15 mg of tirzepatide, respectively. Improvements in all prespecified cardiometabolic measures were observed with tirzepatide.

The most common adverse events with tirzepatide were gastrointestinal, and most were mild to moderate in severity, occurring primarily during dose escalation.

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Efficacy of Bariatric Surgery in the Treatment of Women With Obesity and Polycystic Ovary Syndrome

Bariatric surgery should be prioritised for polycystic ovary syndrome (PCOS) patients as complete remission in patients with obesity depends on the final BMI after weight loss, according to researchers from Shanghai Jiao Tong University School of Medicine Affiliated Sixth People’s Hospital, Shanghai, China.

Writing in the Journal of Clinical Endocrinology & Metabolism, their study recruited 90 women aged 18 to 40 years with BMI≥27.5kg/m2 and waist circumference ≥ 85 cm and fulfilling the 2011 Chinese diagnostic criteria for PCOS; 81 subjects completed the study. In the drug group, patients were administered metformin and an oral contraceptive containing ethinyl-estradiol and cyproterone acetate for the first six months, and metformin alone for the second six months. In the surgical group, patients underwent LSG. The follow-up period was 12 months. The main outcome was the complete remission of PCOS, requiring 6 consecutive regular menstruation cycles or spontaneous pregnancy.

Median BMI at endpoint was 30.1 kg/m2 in the drug group and 23.7 kg/m2 in the surgical group; complete remission rate was 15% and 78%, respectively. Except endpoint BMI, no differences were observed in free androgen index, ovarian morphology, homeostasis model assessment for insulin resistance, and total weight loss between remission and nonremission patients.

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