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Journal Watch 12/01/2022

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 the outcomes between one anastomosis gastric bypass vs. long biliopancreatic limb RYGB, a comparison of weekly subcutaneous semaglutide vs daily liraglutide on body weight, women are more likely to be readmitted after bariatric surgery than men, T2DM resolution at ten-year outcomes from biliopancreatic diversion and changes in gastroesophageal junction compliance during fundoplication (please note, log-in maybe required to access the full paper).

One Anastomosis Gastric Bypass Versus Long Biliopancreatic Limb Roux-en-Y Gastric Bypass

Investigators for Cairo University Hospitals Manial, Cairo, Egypt, writing in Obesity Surgery, have reported that extending the biliopancreatic limb (BPL) length in RYGB to 150cm is as effective as OAGB in remission of comorbidities, including diabetes.

In their prospective study, the RYGB group (n=36) was subjected to long biliary limb Roux-en-Y gastric bypass (LPRYGB) and the OAGB Group (n=36) had one anastomosis gastric bypass. During follow-up, weight, BMI, percentage of excess body weight loss (%EBWL), resolution of obesity-related comorbidities, and quality of life (QoL) were evaluated.

At 12-months, weight loss was significantly higher in the OAGB group. After 12 months, the two groups showed significant improvement of comorbid conditions without significant difference between the two groups. The Qol was significantly higher in the LPRYGB group three, six and 12 months after surgery vs. the OAGB group.

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Effect of Weekly Subcutaneous Semaglutide vs Daily Liraglutide on Body Weight in Adults With Overweight or Obesity Without Diabetes - The STEP 8 Randomized Clinical Trial

Researchers writing on behalf of the STEP 8 Investigators have reported that once-weekly subcutaneous semaglutide added to counselling for diet and physical activity, resulted in significantly greater weight loss at 68 weeks vs once-daily subcutaneous liraglutide. The outcomes were published in JAMA.

The RCT included 338 participants who received once-weekly subcutaneous semaglutide 2.4mg or once-daily subcutaneous liraglutide 3.0mg (both with diet and physical activity) or matching placebo for 68 weeks.

Participants had significantly greater odds of achieving 10% or more, 15% or more, and 20% or more weight loss with semaglutide vs liraglutide (70.9% of participants vs 25.6%, 55.6% vs 12.0% and 38.5% vs 6.0%, respectively; all p<0.001). Gastrointestinal adverse events were reported by 84.1% with semaglutide and 82.7% with liraglutide.

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Trends in Risk Factors for Readmission after Bariatric Surgery 2015-2018

Researchers from Duke University, Durham, NC, have found that women along with non-Hispanic Black and Hispanic adults, are more likely to be readmitted after bariatric surgery. Using data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, they reported that all-cause readmission rates decreased from 4.2% in 2015 to 3.5% in 2018 (p<0.0001). The outcomes were published in SOARD.

The percentage of non-Hispanic Black adults who underwent bariatric surgery increased from 16.7% of the total cohort in 2015 to 18.7% in 2018 (p<0.0001) and the percentage of Hispanic adults increased from 12.1% in 2015 to 13.8% in 2018 (p<0.0001).

Males were less likely to be readmitted compared to females (OR (odds ratio) 0.87; 95% CI: 0.84-0.90) and non-Hispanic Black (OR 1.52; 95% confidence interval (CI): 1.47-1.58)] and Hispanic adults (OR 1.14; 95% CI: 1.09-1.19) were more likely to be readmitted compared to non-Hispanic White adults. LSG (OR 1.27; 95% CI: 1.10-1.48) and RYGB (OR 2.24; 95% CI: 1.93-2.60) were predictive of readmission compared to LAGB.

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Diabetes Resolution at 10 Years After Biliopancreatic Diversion in Overweight and Class 1 Obese Patients with Type 2 Diabetes

Published in Obesity Surgery, researchers from the University of Genova, Genova, Italy, have concluded that Biliopancreatic Diversion (BPD) should be used with caution as a metabolic procedure in the treatment of T2DM in overweight or class 1 obese patients.

In their study, 30 T2DM patients with BMI<35 were investigated at one, five and ten years after BPD, and the results were compared with those of 30 T2DM patients followed for ten years on pharmacological and/or behavioural conventional therapy.

The outcomes revealed that T2DM remission was observed in about 50% of the cases at five and ten years after the operation. In 16 patients (53%), severe BPD-related complications developed, in ten cases requiring a surgical revision of the operation. In the BPD group, one patient died for malignant lymphoma and two patients after surgical revision.

Within the control group, during the ten-year follow-up, no changes in the diabetic status were observed, being the FBG and HbA1C mean values higher than those recorded in the BPD patients at any follow-up time. All T2DM subjects of the control group were alive at the end of the ten-year follow-up.

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Impedance planimetry (EndoFLIP™) reveals changes in gastroesophageal junction compliance during fundoplication

Researchers from the University of Chicago Medical Center, Chicago, IL, have described the changes in compliance during anti-reflux surgery (laparoscopic fundoplication) and hypothesised that compliance is a better predictor of patient outcomes than distensibility (DI).

Writing in Surgical Endoscopy, the authors reviewed 144 patient-reported outcomes two years after surgery. Compliance is strongly associated with DI (r = 0.96), and a comparison of measurements showed similar trends at specific time points during the operation. After hernia reduction, compliance at the GEJ was 168 ± 74 mm3/mmHg, cruroplasty 79 ± 39 mm3/mmHg, and fundoplication 90 ± 33 mm3/mmHg (all comparisons p<0.05). GEJ compliance of 80–92 mm3/mmHg after fundoplication was associated with the best patient-reported outcome scores.

They concluded that GEJ compliance is an underutilised FLIP measurement and warrants further investigation.

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