Journal Watch 12/10/2022

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 bariatric surgery associated with a decrease in CVD, duodenal switch conversions are an effective salvage procedure for insufficient weight loss and/or weight regain after previous bariatric surgery, bariatric surgery patients had a 37% reduction in the risk of developing colorectal cancer vs. non-surgical patients, why Swedish patients undergo surgery, adverse events with esophageal stenting, the outcomes from a RCT comparing Vonoprazan to the PPI lansoprazole for erosive esophagitis, and the outline of a study examining whether zoledronic acid prevents bone and muscle loss after bariatric surgery (please note, log-in maybe required to access the full paper).


Association of Bariatric Surgery With Cardiovascular Outcomes in Adults With Severe Obesity and Nonalcoholic Fatty Liver Disease

Researchers from the Ohio State University, Columbus, OH, have report that bariatric surgery, compared with nonsurgical care, was associated with significant reduction in cardiovascular disease (CVD) risk in individuals with severe obesity and Nonalcoholic Fatty Liver Disease (NAFLD).


Writing in JAMA Network Open, examined the association between bariatric surgery and CVD risk in individuals with severe obesity and NAFLD. The study included 86, 964 adults (59,773 women [68.7%]). Of these individuals, 30,300 (34.8%) underwent bariatric surgery and 56,664 (65.2%) received nonsurgical care.


In the surgical group, 1,568 individuals experienced incident cardiovascular events compared with 7,215 individuals in the nonsurgical group (incidence rate difference, 4.8 [95% CI, 4.5-5.0] per 100 person-years). At the end of the study, bariatric surgery was associated with a 49% lower risk of CVD (adjusted hazard ratio [aHR], 0.51; 95% CI, 0.48-0.54), compared with nonsurgical care. The risk of primary composite CVD outcomes was reduced by 47% (aHR, 0.53 [95% CI, 0.48-0.59), and the risk of secondary composite CVD outcomes decreased by 50% (aHR, 0.50; 95% CI, 0.46-0.53) in individuals with vs without surgery.


“The findings provide evidence in support of bariatric surgery as an effective therapeutic tool to lower elevated CVD risk for select individuals with obesity and NAFLD,” the authors conclude. “Although bariatric surgery is a more aggressive approach than lifestyle modifications, it may be associated with other benefits, such as improved quality of life and decreased long-term health care burden.”


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Duodenal Switch Conversion in Non-responders or Weight Recurrence Patients

Investigators from Orlando Regional Medical Center, Orlando, FL, have concluded that duodenal switch conversions are an effective salvage procedure for insufficient weight loss and/or weight regain after adjustable gastric band, sleeve gastrectomy and Roux-en-Y gastric bypass and it is also safe, associated to low readmission, reoperation and mortality rates.


Reporting in Obesity Surgery, they aimed to evaluate efficacy and safety of duodenal switch conversion as a salvage procedure. Fifty patients who underwent duodenal switch conversions were retrospectively studied. Excess weight loss % and total body weight loss % were compared between primary procedure and duodenal switch conversion. Overall complication, emergency department visits, readmissions, reoperation, and mortality rates were described, analysed and compared to the current literature.


Every excess weight loss % and total body weight loss % comparison at 6, 12, and 24 months, demonstrated a statistically significant superiority in weight loss after duodenal switch conversion (p < 0.05). The mean operative time of adjustable gastric band, sleeve gastrectomy, Roux-en-Y gastric bypass (1 and 2 stages) conversions to duodenal switch were 208, 146, 187, and 152 min, respectively, while the mean length of stay was 3.38 days.


There were no statistically significant differences were perceived regarding the primary procedure. The overall complication rate was 18% (nine patients); three patients (6%) had one emergency department visit; readmissions accounted for 12% of cases (six patients); the reoperation rate was 10% (five patients); no fatal outcomes were recorded.


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The Effect of Bariatric Surgery on Reducing the Risk of Colorectal Cancer: a Meta-Analysis of 3,233,044 Patients

Researchers led by the Military Institute of Aviation Medicine, Warsaw, Poland, have found that patients who underwent bariatric surgery had a 37% reduction in the risk of developing colorectal cancer compared with patients with obesity who had no surgery.


Reporting in SOARD, they investigated the effect of bariatric surgery on the risk of developing colorectal cancer in patients with obesity. The meta-analysis identified 13 studies (3,233,044 patients), the mean time of follow-up was 9.5±7.9 years.


The sub-analysis of studies with minimum ten years of follow-up showed 32% decrease in risk of developing colorectal cancer, compared with patients with obesity who had no surgery.


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Do reasons for undergoing bariatric surgery influence weight loss and health-related quality of life?–A Swedish mixed method study

Investigators from the Örebro University, Örebro, Sweden, have found that the most reported reasons for undergoing bariatric surgery were a wish for improved medical condition and to make daily life easier.


Reporting in PLOSone, they explored Swedish patients’ reasons for undergoing bariatric surgery and whether there were sex and age differences and associations with weight loss and health-related quality of life (HRQoL).


In total, 688 patients (528 women and 160 men) were included in the study. The most common reason for undergoing bariatric surgery was pain in different body parts. A wish for an improved medical condition was reported by most patients (59%, n=408), followed by physical limitations making daily life difficult (42%, n=288). Men and women reported similar reasons. Younger patients were more distressed about physical appearance (p=0.001) and older patients wanted to improve their medical condition (p=0.013). Health-related quality of life improved irrespective of reasons for undergoing surgery.


Factors associated with the decision for surgery showed that there were few sex differences, but age seemed to be a factor. The HRQoL trajectory showed improvement regardless of reasons for undergoing surgery.


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Adverse Events with Esophageal Stenting: A Call to Optimize Device and Endoscopic Placement

Investigators from Ohio State University have reported that inpatient esophageal stents (ES) are placed predominantly in benign conditions with esophageal leak/fistula being the most common indication. Stent-related AEs account for a significant burden of readmissions, particularly when placed for benign conditions.


Writing in Techniques and Innovations in Gastrointestinal Endoscopy, they sought to evaluate predictors and causes for early readmission following ES placement in hospitalised patients. The National Readmission Database 2016-2018 was queried to identify hospitalized patients with an ICD-10-CM code for endoscopic ES placement. Primary outcome was early (≤30-day) readmission rate. Univariate and multivariable logistic regression models were used to evaluate predictors of early readmission.


A total of 949 patients underwent index ES placement and a majority (67%, n=634) of patients had benign indications. Overall, the most common indication was benign esophageal leak/fistula (n=359) followed by malignant dysphagia from esophageal neoplasm (n=252). The 30-day readmission rate was 26% (n=251); with higher rates for benign (29%) compared to malignant (22%) indications, p=0.09. An analysis of primary diagnosis for early readmissions revealed that stent-related AEs were higher in the benign than in the malignant group (42% vs 23% respectively, p=0.008). Multivariable analysis revealed that ES placement for esophageal leak/fistulas (OR 1.98; 95% CI: 1.20 – 3.24; p=0.022) was the only significant variable associated with early readmission.


They concluded that there is a need for focused research refining indications, optimising techniques and improved stent technology.


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Vonoprazan versus lansoprazole for healing and maintenance of healing of erosive esophagitis: a randomized trial

US researchers have concluded that vonoprazan was non-inferior and superior to the PPI lansoprazole in healing and maintenance of healing of erosive esophagitis. This benefit was seen predominantly in more severe erosive esophagitis.


Writing in Gastroenterology, they explained that adults with erosive esophagitis were randomised to once-daily vonoprazan 20mg or lansoprazole 30mg for up to eight weeks. Patients with healing were re-randomised to once-daily vonoprazan 10mg, vonoprazan 20mg, or lansoprazole 15mg for 24 weeks. Primary endpoints, percentage with healing by week-eight endoscopy and maintenance of healing at week-24 endoscopy, were assessed in non-inferiority comparisons (non-inferiority margins=10%), with superiority analyses pre-specified if non-inferiority was demonstrated. Analyses of primary and secondary endpoints were performed using fixed-sequence testing procedures.


From 1,024 patients in the healing phase, vonoprazan was non-inferior to lansoprazole in primary analysis and superior on exploratory analysis of healing (92.9 vs. 84.6%; difference=8.3%, 95% CI 4.5-12.2%). Secondary analyses showed vonoprazan non-inferior in heartburn-free days (difference=2.7%, -1.6-7.0%), and superior in healing Grade C/D esophagitis at week two (difference=17.6%, 7.4-27.4%).


Among 878 patients in maintenance phase, vonoprazan was non-inferior to lansoprazole in primary analysis and superior on secondary analysis of maintenance of healing (20mg vs. lansoprazole difference=8.7%, 1.8-15.5%; 10mg vs. lansoprazole difference=7.2%, 0.2-14.1%) and secondary analysis of maintenance of healing Grade C/D esophagitis (20mg vs. lansoprazole difference=15.7%, 2.5-28.4%; 10mg vs. lansoprazole difference=13.3%, 0.02-26.1%).


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Zoledronic Acid for prevention of bone and muscle loss after BAriatric Surgery (ZABAS)-a study protocol for a randomized controlled trial

Researchers at the University Hospital of Southern Denmark, Odense, Denmark, have instigated a study to examine the effects of zoledronic acid for the prevention of bone and muscle loss after bariatric surgery.


Reporting in BMC Trials, this randomised double-blind placebo-controlled study will recruit 60 women and men with obesity aged 35 years or older who will be randomised to either zoledronic acid (5mg in 100ml isotonic saline) or placebo (100ml isotonic saline only) three weeks before surgery with Roux-en-Y-gastric bypass (RYGB) or sleeve gastrectomy (SG). Follow-up assessments will be performed 12 and 24 months after surgery. The primary outcome is changes in lumbar spine volumetric bone mineral density (vBMD) assessed by quantitative computed tomography (QCT).


The researchers added that the results from this study will be instrumental for the evidence-based care of patients undergoing bariatric surgery.


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