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 an examination of the combined SLEEVEPASS and SM-BOSS outcomes, STEP Teens semaglutide results, pregnancy after bariatric surgery, Endoscopic management of refractory leak and gastro-cutaneous fistula post-LSG, and Surgery and mortality and CKD (please note, log-in maybe required to access the full paper).
Validation of the Individual Metabolic Surgery Score for Bariatric Procedure Selection in the Merged Data of Two Randomized Clinical Trials (SLEEVEPASS and SM-BOSS)
Investigators from the SLEEVEPASS and SM-BOSS clinical trials, writing in SOARD, have concluded that remission rates of T2D were not statistically different after laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) among all patients and among patients with mild, moderate and severe diabetes stratified by the Individualised Metabolic Surgery (IMS).
The researchers sought to assess the feasibility of IMS score in facilitating procedure selection between the two procedures for patients with severe obesity and type 2 diabetes (T2D). IMS score categorises T2D severity (mild, moderate, and severe) based on four independent preoperative predictors of long-term remission: T2D duration, number of diabetes medications, insulin use, and glycaemic control.
Using merged individual patient-level five-year data from the SLEEVEPASS and SM-BOSS studies, in total 139 out of 155 patients with T2D had available preoperative data to calculate IMS score: mild stage (n=41/139), moderate stage (n=77/139), severe stage (n=21/139).
At five years, 135 (87.1%, 67 LSG/68 LRYGB) were available for follow-up and 121 patients had both pre- and postoperative data. Diabetes remission rates according to preoperative IMS score were: mild stage 87.5% (n=14/16) after LSG and 85.7% (n=18/21) after LRYGB (P=0.999), moderate stage 42.9% (n=15/35) and 45.2% (n=14/31) (P=0.999), and severe stage 18.2% (n=2/11) and 0% (n=0/7) (P=0.497), respectively. The T2D remission rate varied significantly between the stages: mild vs. moderate OR 8.3 (p<0.001); mild vs. severe OR 52.2 (p<0.001); and moderate vs. severe OR 6.3 (p=0.020).
The author concluded that remission rates of T2D were not statistically different after LSG and LRYGB among all patients and among patients with mild, moderate and severe diabetes stratified by the IMS score. However, IMS score seemed to be useful in predicting long-term T2D remission after bariatric surgery.
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Once-Weekly Semaglutide in Adolescents with Obesity
STEP TEENS Investigators, reporting in the New England Journal of Medicine, have concluded that for adolescents with obesity, once-weekly treatment with a 2.4mg dose of semaglutide plus lifestyle intervention, resulted in a greater reduction in BMI than lifestyle intervention alone.
STEP TEENS is a double-blinded, parallel-group, randomised, placebo-controlled trial, which enrolled adolescents (12 to <18 years of age) with obesity or with overweight and at least one weight-related coexisting condition. Participants were randomly assigned in a 2:1 ratio to receive once-weekly subcutaneous semaglutide (at a dose of 2.4 mg) or placebo for 68 weeks, plus lifestyle intervention. The primary end point was the percentage change in BMI from baseline to week 68; the secondary confirmatory end point was weight loss of at least 5% at week 68.
The mean change in BMI from baseline to week 68 was −16.1% with semaglutide and 0.6% with placebo (p<0.001). At week 68, a total of 95 of 131 participants (73%) in the semaglutide group had weight loss of 5% or more vs. 11 of 62 participants (18%) in the placebo group (p<0.001). Reductions in body weight and improvement with respect to cardiometabolic risk factors (waist circumference and levels of glycated hemoglobin, lipids [except high-density lipoprotein cholesterol], and alanine aminotransferase) were greater with semaglutide than with placebo.
Serious adverse events were reported in 15 of 133 participants (11%) in the semaglutide group and in 6 of 67 participants (9%) in the placebo group.
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The Timing of Pregnancies After Bariatric Surgery has No Impact on Children’s Health—a Nationwide Population-based Registry Analysis
There were no differences noted in frequency of hospitalisation and diagnoses leading to hospitalisation in the first year of life, regardless of the interval between bariatric surgery and birth.
The study authors from the Medical University of Vienna, Vienna, Austria, writing in Obesity Surgery, sought to analyse health outcomes in children born to mothers who had undergone bariatric surgery. The surgery-to-delivery interval was studied.
A total of 1,057 women gave birth to 1,369 children. The offspring’s data were analyzed for medical health claims based on International Classification of Diseases (ICD) codes and number of days hospitalised. Three different surgery-to-delivery intervals were assessed: 12, 18, and 24 months.
Overall, 421 deliveries (31%) were observed in the first two years after surgery. Of these, 70 births (5%) occurred within 12 months after surgery. The median time from surgery to delivery was 34 months. Overall, there were no differences noted in frequency of hospitalisation and diagnoses leading to hospitalization in the first year of life, regardless of the surgery-to-delivery interval.
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Endoscopic management of refractory leak and gastro-cutaneous fistula after laparoscopic sleeve gastrectomy: a randomized controlled trial
Endoscopic intervention is a good option in managing post-LSG gastric leak and gastro-cutaneous fistula that do not respond to conservative measures in stable patients, according top researchers from Zagazig University, Zagazig, Egypt.
Writing in Surgical Endoscopy, the authors conducted a prospective randomised clinical study who had LSG and had a complicated post-LSG leak or gastro-cutaneous fistula between December 2019 and March 2021.
Thirty patients were randomised into two groups: Surgery Group (SG, n=15) and Endoscopy Group (EG, n=15). Females constituted 73.3% and 80% in SG and EG, respectively. Median time-to-gastric leak post LSG was six (range: 4–7) days in both groups. SG patients were surgically managed with primary repair of the gastric fistula and gastrojejunostomy in 13 patients or converting SG into Roux-en-Y gastric bypass in two patients, while EG patients were endoscopically managed with stitching, stenting, stenting and dilation, and clipping and dilation in 5, 4, 4 and 2 patients, respectively.
They noted that the incidence of recurrent leak during 1st week was significantly higher in SG than EG ( p<0.001). No mortality reported in EG, while two patients died in the sleeve group (p=0.48).
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Bariatric Surgery and Risk of Death in Persons With Chronic Kidney Disease
US researchers, reporting in the Annals of Surgery, have found that bariatric surgery is associated with a reduction in mortality in pre-dialysis patients regardless of developing ESRD.
This retrospective cohort study investigated the association between having surgery and risk of mortality for up to five years and whether the association was modified by incident ESRD during the follow-up period.
In total, 802 patients with class II and III obesity and pre-dialysis CKD stages 3–5 who underwent bariatric surgery were matched to patients who did not have surgery (n=4,933). Mortality was obtained from state death records and ESRD was identified through state-based or healthcare system-based registries. Adjusting for incident ESRD, bariatric surgery was associated with a 79% lower five-year risk of mortality compared to matched controls (p< 0.001). Incident ESRD did not moderate the observed association between surgery and mortality (p=0.58).
The authors added that the findings are significant because patients with CKD are at relatively high risk for death with few efficacious interventions available to improve survival.
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