Journal watch 1/10/2025

Welcome to our regular 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 systematic review and meta-analysis of TORe, RYGB in adolescents and POSE-2, standardised postoperative protocol enhances adherence to postoperative care, MBS and steatotic liver disease, and ForePass outperforms semaglutide in swine model, and more (please note, log-in maybe required to access the full paper).

Transoral Outlet Reduction for Dumping Syndrome After Roux-En-Y Gastric Bypass: a Comprehensive Systematic Review and Meta-Analysis

Transoral outlet reduction (TORe) is a safe and effective minimally invasive treatment for patients with medically refractory dumping syndrome, according to a systematic review and meta-analysis from researchers at the Indiana University School of Medicine.

Writing in Obesity Surgery, their meta-analysis evaluated six studies (333 post-RYGB patients with dumping syndrome) and reported on the the efficacy and safety of TORe for dumping syndrome.

The pooled clinical success of TORe was 83% (95% CI 71%-90%, I2 = 74%). Furthermore, TORe resulted in a significant improvement in Sigstad’s score (MD − 11.12 [95% CI -15.33 to − 6.91], P < 0.001, I2 = 89%). The rate of serious adverse events was 3% (95% CI 0.7%-12.4%, I2 = 68%).

The study authors added that further prospective studies with longer follow-up durations are warranted to validate these findings.

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Long-term outcomes of RYGB in the adolescent population: A Systematic Review and Single-Arm Meta-Analysis

Researchers from the UK and US have found that Roux-en-Y gastric bypass (RYGB) in adolescents leads to significant weight loss and comorbidity resolution but carries risk of complications and requires monitoring for nutritional deficiencies.

Writing in SOARD, this systematic review and single-arm meta-analysis included 12 studies (n=522 adolescents). The mean age was 17.5 years (13-21 years), 73.6% of patients were female, and the mean follow-up was 48.4 months. Baseline BMI was 50.1kg/m2. BMI reduction peaked at one year with an absolute reduction of 19.1kg/m2, 36.6% total loss, and 67.7% excess BMI loss.

At five years, absolute reduction of BMI was 19.1kg/m2, percentage loss was 31.5% and excess BMI loss was 70.5%. Comorbidity remission rates were 85% for dyslipidaemia, 73% for hypertension, 85% for type 2 diabetes and 68% for obstructive sleep apnoea. Iron and Vitamin B12 deficiency rates were higher postoperatively and the complication rate was 29.1%.

The authors said that further long-term studies are essential.

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Efficacy, Safety, and Metabolic Outcomes of Primary Obesity Surgery Endoluminal 2 (POSE-2) for Obesity: A Systematic Review and Meta-Analysis

An international team of researchers has found that Primary Obesity Surgery Endoluminal 2 (POSE-2) demonstrates promising weight loss and selected metabolic improvements in HbA1c and cholesterol with a favourable short-term safety profile.

Writing in Obesity Surgery, the systematic review and meta-analysis of one randomised controlled trial (RCT) and three observational studies (n=210) to evaluate the procedure’s efficacy, safety and metabolic outcomes (HbA1c, glucose, cholesterol, triglycerides, LDL, and liver enzymes).

Pooled percent total body weight loss (%TBWL) was 13.23% (I2 = 87%) at three months, 16.22% (I2 = 76%) at six months and 16.17% (I2 = 0%) at 12 months, showing high heterogeneity early but consistency by 12 months. Percent excess weight loss (%EWL) at 12 months was 56.95% (I2 = 0%). HbA1c improved at six months (SMD = –0.67, p=0.036, I2 = 0%), exceeding the minimal clinically important difference (–0.5%), and cholesterol decreased significantly (SMD = –0.25, p=0.013, I2 = 0%). Fasting glucose and liver enzymes showed nonsignificant favourable trends with high heterogeneity for ALT/AST (I2 > 90%). Adverse events were infrequent (2.5–5%), mostly mild, with rare perforations or bleeding.

The authors added that as the evidence is limited to four studies with small sample size, short follow-up and variable heterogeneity, addition larger, longer RCTs are required.

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Implementation of a Standardized Postoperative Protocol Enhances Adherence to Postoperative Care and Quality of Life Following Bariatric Surgery

Implementing a standardised postoperative care protocol can improve patient adherence to treatment and quality of life after Roux-en-Y gastric bypass (RYGB), according to researchers from Brazil.

Writing in Nutrition, the study authors assessed the impact of implementing a standardised postoperative care protocol on patients’ adherence to vitamin and mineral supplementation, multidisciplinary team follow-up, and health-related quality-of-life (HRQoL) during the first year after RYGB. This ambispective cohort study included patients undergoing RYGB at a Brazilian university hospital. Two groups were compared: those receiving usual postoperative care (UC) and those managed under the new standardised protocol (SP).

Adherence to multidisciplinary team follow-up was 81.7% in the UC and 96.9% in the SP (p=.003). The SP group showed higher vitamin D serum levels at three, six and 12 months (p<.001). Overall, the percentage of multivitamin, calcium, vitamin D and vitamin B12 use was remarkably lower in the UC group compared to the SP group, from 30 days to one year postoperative (p<0.005). At 12 months, the SP group also showed higher scores of general health (p<0.001) and social functioning (p=0.004) in HRQoL.

The authors concluded that these findings suggest that long-term outcomes for bariatric surgery patients could be optimised.

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Metabolic bariatric surgery is associated with reduced adverse hepatic and extrahepatic outcomes, and lower all-cause mortality, in patients with steatotic liver disease

In patients with steatotic liver disease (SLD), metabolic bariatric surgery (MBS) is associated with significant reductions in the rates of adverse hepatic and extrahepatic outcomes and all-cause mortality over four years' follow-up, according to researchers from University of Liverpool, Liverpool, UK.

Writing in Diabetes, Obesity and Metabolism, they assessed the impact of MBS on hepatic and extrahepatic morbidity and mortality in individuals with SLD. They identified 15,262 and 540,031 patients (for the MBS and no-MBS cohorts, respectively); 14,970 patients/cohort after PSM (mean age: 46.7 vs. 47.4; female: 74.3% vs. 75.7%; mean follow-up, 4.1 years).

MBS was associated with reduced hazard ratio (HR) of MALO (0.84, 95% CI 0.75–0.95), MACE (0.52, CI 0.47–0.57), MAKE (0.54, CI 0.41–0.72), obesity-related cancers (0.58, CI 0.50–0.67) and ACM (0.49, 0.43–0.56). In subgroup analyses, MBS was associated with reduced HR of MALO, MACE, MAKE, obesity-related cancers, and ACM in females, patients with T2D, BMI > 50 kg/m2 and irrespective of surgery type.

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ForePass outperforms Semaglutide in weight control, glucose metabolism, and gut microbiota in swine

Italian researchers have reported that the ForePass device produced superior insulin sensitivity and weight outcomes versus semaglutide in growing pigs.

Writing in Diabetes, Obesity and Metabolism, this study evaluated the metabolic efficacy of ForePass, a novel, incision-free, reversible, endoscopically delivered device that mimics biliopancreatic diversion. The primary aim was the superiority of ForePass over Semaglutide in improving insulin sensitivity (SI). Secondary aims included effects on weight gain, endogenous glucose production (EGP), disposition index (DI), oral glucose rate of appearance, plasma metabolomics, and faecal microbiota.

Over 30 days, 12 young Landrace pigs (46.7 ± 1.1 kg) received ForePass, twice-weekly semaglutide, or sham endoscopy. Sample size was calculated a priori for the primary endpoint, yielding n=4 per group. Body weight was monitored, and oral glucose tolerance testing (OGTT) with stable isotope tracers assessed hepatic glucose disposal. SI, insulin secretion, glucose rate of appearance (Ra), metabolomics, and faecal microbiota were analysed.

ForePass improved SI more than semaglutide (2.75 ± 0.37 vs. 1.34 ± 0.21 min−1·pM−1) and sham (0.78 ± 0.46; p <0.0.05). Weight gain was 2.0 kg (4%) with ForePass, versus 16.3 kg (36%) with semaglutide and 21.1 kg (47%) with sham (p <0.0001). Semaglutide reduced weight gain by 11% versus sham (p <0.05). DI was 2.6-fold higher with ForePass than semaglutide and 3.5-fold higher than sham. ForePass reduced oral glucose Ra by 40% versus semaglutide and 30% versus sham, while EGP 46% was lower than semaglutide and 51% lower than sham (p<0.0001). Metabolomics showed ForePass increased ketogenic and branched-chain amino acids, whereas semaglutide raised lactate and alanine.

They authors concluded that as the ForePass device has distinct effects on glucose disposal, metabolomics and microbiota, this supports the notion that the device is a reversible, incision-free endoscopic therapy that may bridge the gap between pharmacological and surgical options for obesity and T2DM.

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