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Journal Watch 11/01/2023

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 the impact of financial incentives on post-op follow-up, mid-term health-related quality of life after BPD-DS, hiatal hernia diagnosis prior to LSG and bariatric surgery impacts Telomere length (please note, log-in maybe required to access the full paper).

Financial Incentives to Improve Patient Follow-up and Weight Loss After Bariatric Surgery

US researchers led by University of Michigan, Ann Arbor, MI, have reported that a financial incentives programme significantly increased follow-up after bariatric surgery for up to six months, but did not increase weight loss.

Reporting the findings in the Annals of Surgery, participants received incentives for attending postoperative appointments at one, three and six months which doubled when participants weighed less than their prior visit. Participants were matched with contemporary patients from control practices by demographics.

One hundred ten programme participants were matched to 203 historic programme practice patients. The control group had 273 pre-intervention patients and 327 post-intervention patients. In difference-in-differences analyses, the intervention increased follow-up rates at 1 month (+14.8%, p<0.0001), 3 months (+29.4%, p<0.0001) and six months (+16.4%, p<0.0001), but not at 12 months. There were no statistically significant differences in excess weight loss.

“Our study supports use of incentivized approaches as one way to improve postoperative follow-up, but may not translate into greater weight loss without additional supports,” the authors concluded.

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Impact on Mid-Term Health-Related Quality of Life after Duodenal Switch: a Systematic Review and Meta-Analysis

A meta-analysis by US researchers, writing in Obesity Surgery, has found that biliopancreatic diversion with duodenal switch (BPD-DS) results in an improvement in mid-term health-related quality of life (HrQoL).

The researchers identified 937 patients with obesity undergoing BPD-DS from 12 studies. Minimal clinically important differences (MCID) were reached for the physical component summary score (PCS) of the 36-Item Short-Form Health Survey (SF-36) (MD = 13.4) and impact of weight on quality of life (IWQOL)-Lite total score (MD = 48.7). Similarly, MCIDs were attained in the Laval questionnaire and SF-36 subscales.

“Our meta-analysis demonstrated an improvement in mid-term HrQoL after BPD-DS,” they concluded. “Despite the promising trends demonstrated in this meta-analysis, further studies with large sample sizes are needed to evaluate the impact of HrQoL on patients with obesity after BPD-DS.”

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Comparison of upper gastrointestinal series and symptom questionnaires with intraoperative diagnosis of hiatal hernia during sleeve gastrectomy

Investigators from the University of Miami Miller School of Medicine, FL, have found that Gastroesophageal Reflux Disease Questionnaire (GerdQ), Brief Esophageal Dysphagia Questionnaire (BEDQ) and UGI unreliably identify hiatal hernia in the pre-operative setting and should not influence intraoperative evaluation of the hiatus during sleeve gastrectomy (SG).

Writing in SOARD, their study compared pre-operative and intra-operative hiatal hernia detection rates in patients undergoing laparoscopic SG. As part of a randomised trial evaluating the role of routine crural inspection during SG, an initial cohort was prospectively studied to assess the correlation between preoperative upper gastrointestinal series (UGI), reflux and dysphagia symptoms, and intraoperative hiatal hernia diagnosis. Preoperatively, patients completed GerdQ, BEDQ and UGI. Intraoperatively, patients with an anteriorly visible defect underwent hiatal hernia repair followed by SG. All others were randomised to standalone SG or posterior crural inspection with repair of any hiatal hernia identified prior to SG.

The reported that from the 100 patients (72 female) enrolled, pre-operative UGI identified hiatal hernia in 28% (26/93) of patients. Intraoperatively, hiatal hernia was diagnosed during initial inspection in 35 patients. Diagnosis was associated with older age, lower body mass index, and Black race, but did not correlate with GerdQ or BEDQ. Using the standard conservative approach, compared to intraoperative diagnosis, sensitivity and specificity of UGI were 35.3% and 80.7%, respectively. Hiatal hernia was identified in an additional 34% (10/29) of patients randomized to posterior crural inspection.

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Telomere length dynamics measured by flow-FISH in patients with obesity undergoing bariatric surgery

European researchers led by a team from Aachen University, Aachen, Germany, have demonstrated that bariatric surgery affects not only body weight but also biomarkers of aging, such as Telomere length (TL).

Writing in Scientific Reports, the researchers sought to elucidate the link between TL and obesity by using the gold standard for the measurement of TL, flow-FISH, and to determine whether bariatric surgery has an impact on telomeres as an established biomarker of aging.

Lymphocyte and granulocyte absolute and age-adjusted (aa) TL were analysed by flow-FISH before (preoperative cohort, n=45) and after surgery (follow-up cohort, n=35) at month 5.5 ± 3.9. The initial lymphocyte aaTL was significantly shorter (-0.37 kb ± 0.18 kb, p= 0.045) in patients with obesity, while the granulocyte aaTL was not different from that in the healthy comparison population (0.28 kb ± 0.17 kb, p=0.11).

The concluded that patients suffering from obesity have significantly shorter lymphocyte TL using flow-FISH and, along with and dependent on the degree of weight reduction after bariatric surgery, TL significantly increased in both lymphocytes and granulocytes after a mean of 5.5 months.

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