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Journal Watch 13/12/2023

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 conversion from OAGB to RYGB for GERD, researchers endorse Swiss-Finnish Bariatric Metabolic Outcome Score, managing post-SG portomesenteric vein thrombosis, American Diabetes Association - Standards of Care in Diabetes 2024 and early- and later-stage persistence with AOMs, and more (please note, log-in maybe required to access the full paper).

Conversion of one-anastomosis gastric bypass (OAGB) to Roux-en-Y gastric bypass (RYGB) for gastroesophageal reflux disease (GERD): who is more at risk? A multicenter study

French and Italian researchers have found that a weakening of the esogastric junction appear to be highly frequent in patients operated on for one-anastomosis gastric bypass (OAGB) and converted to Roux-en-Y gastric bypass (RYGB) for severe reflux.

Reporting in Surgical Endoscopy, this retrospective multi-centre study sought to analyse the characteristics of OAGB patients converted to RYGB for gastroesophageal reflux disease (GERD) not responding to medical treatment. The conversion was performed with resection of the previous gastro-jejunal anastomosis and the use of the afferent loop as a new biliary loop.

Conversion to RYGB was performed on average 60±35.6 months after OAGB and seven patients (5.5%) experienced an early postoperative complication (four patients grade IIIb and 3 grade IIb), and three (2.4%) a late complication. Patients showed further weight loss after RYGB conversion and an average of 24.8±21.7 months after surgery, with a mean % of total weight loss (%TWL) of 6.9±13.6kg.

The authors added that from a clinical point of view, the problem of GERD was definitively solved in more than 90% of patients and the correct creation of the gastric pouch could play an important role in reducing the risk of conversion to RYGB for GERD.

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Standardized Assessment of Metabolic Bariatric Surgery Outcomes - Secondary Analysis of 2 Randomized Clinical Trials

European investigators have stated that the Swiss-Finnish Bariatric Metabolic Outcome Score (SF-BARI Score) is a simple, relevant and feasible composite tool to define and measure MBS outcomes, enabling standardised reporting.

Writing in JAMA Surgery, their study carried out an assessment of a bariatric surgery outcome score is based on the secondary analysis of merged five-year individual patient data (n=457) of two large randomised clinical trials (the Swiss Multicenter Bypass or Sleeve Study and the Finnish Laparoscopic Gastric Bypass Vs Sleeve Gastrectomy to Treat Morbid Obesity).

Outcomes for the SF-BARI Score were available for 435 patients (95.2%) at one year and 398 patients (87.1%) at five years and for SF-BARI Score QOL in 289 (63.2%) patients at one year and 318 patients (69.6%) at five years. The SF-BARI Score was correlated with both the SF-BARI Score QOL (p<0.001) and %TWL (p<0.001) and with the Bariatric Analysis and Reporting Outcome System (p<0.001).

Score outcomes were characterised as excellent, very good, good, fair, and suboptimal response. There was a statistically significant difference in scores at 1 vs 5 years (p=0.003) and the gastric bypass group had a higher score compared with the sleeve gastrectomy group (p<0.001).

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Routine Extended (30 days) Chemoprophylaxis for Patients Undergoing Laparoscopic Sleeve Gastrectomy May Reduce Portomesenteric Vein Thrombosis Rates

Routine extended (30 day) chemoprophylaxis for all sleeve gastrectomy (SG) may reduce portomesenteric vein thrombosis (PMVT) rate but lead to a higher bleeding rate post-operatively, according to research led by investigators from NYU Langone Medical Center, Bellevue Hospital Center, New York.

From 2012-2018, SG patients were discharged on extended chemoprophylaxis for patients who were deemed “high-risk” for VTE, including patients with BMI >50 and previous VTE. However, from 2018-2021, extended chemoprophylaxis was broadened to include patients with positive pre-operative thrombophilia panels (including Factor VIII). After 2021, all SG were routinely discharged on extended chemoprophylaxis.

A total of 8,864 patients underwent SG and the overall incidence of PMVT was 33/8864 (0.37%). Converting from selective extended chemoprophylaxis (Group 1) to routine extended chemoprophylaxis (Group 3) decreased the rate of PMVT from 0.55% to 0.21% (p=0.13). There was a significantly higher overall bleeding rate (0.85%), including delayed bleeds (0.34%) in the routine extended chemoprophylaxis patients (p<0.05).

The authors added that the vast majority of the increased bleeds are delayed and can be managed non-operatively.

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American Diabetes Association - Standards of Care in Diabetes 2024

The American Diabetes Association (ADA) has released the ‘Standards of Care in Diabetes - 2024, a set of comprehensive and evidence-based guidelines for managing type 1, type 2, gestational diabetes, and prediabetes based on the latest scientific research and clinical trials.

It includes strategies for diagnosing and treating diabetes in both youth and adults, methods to prevent or delay type 2 diabetes and its associated comorbidities like cardiovascular disease (CVD) and obesity, and therapeutic approaches aimed at minimizing complications and enhancing health outcomes.

Notable updates to the Standards of Care in Diabetes - 2024 include:

  • New updates in managing obesity in people with diabetes, including approaches to reduce therapeutic inertia, support more personalization, and incorporate additional obesity measurements beyond body mass index (i.e., waist circumference, waist-to-hip ratio, and/or waist-to-height ratio).

  • More guidance on the use of new obesity medications, glucagon-like peptide 1 (GLP-1) agonists or dual glucose-dependent insulinotropic polypeptide (GIP) receptor agonists, to reach sustained weight management goals.

  • A focus on hypoglycemia prevention and management.

  • Emphasis on screening people with diabetes for nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis at primary care and diabetes clinics.

The ADA annually updates its Standards of Care through the efforts of its Professional Practice Committee (PPC). Comprising 21 global experts from diverse professional backgrounds, the PPC includes physicians, nurse practitioners, certified diabetes care and education specialists, registered dietitians, pharmacists, and methodologists.

To access our summary, please click here

To access the Standards of Care, please click here

Early- and later-stage persistence with antiobesity medications: A retrospective cohort study

Later-stage persistence with antiobesity medication (AOM) varies considerably based on the drug and the weight loss at six months, according to researchers from the Cleveland Clinic, Cleveland, OH.

The study's identified 911 patients with an initial AOM with a median baseline BMI of 38. At three months 44% were persistent with AOM, 33% at six months and 19% at 12 months. Across categories of AOM, the highest 1-year persistence was in patients receiving semaglutide (40%) and was associated with higher odds of one-year persistence and naltrexone-bupropion was associated with lower odds, compared with phentermine-topiramate.

For patients who were persistent at six months, a 1% increase in weight loss at six months was associated with 6% increased odds of persistence at one year.

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