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Journal Watch 14/2/2024

Updated: Feb 28

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 T2DM remission despite weight recurrence, costs post-SG and RYGB in T2DM patients, LSG vs LRYGB outcomes from RCTs, OAGB outperforms LSG, Preoperative WL and complication rates post-op and cognition following bariatric surgery, and more (please note, log-in maybe required to access the full paper).

Continued Diabetes Remission Despite Weight Recurrence: Gastric Bypass Long-Term Metabolic Benefit

Type-2 diabetes mellitus (T2DM) remission rates after Roux-en-Y gastric bypass (RYGB) are maintained despite weight recurrence (WR), indicating a concurrent weight-loss independent metabolic benefit likely facilitated by bypassing the proximal small-intestine, according to researchers from the Mayo Clinic, Rochester, MN.

Reporting in the Journal of the American College of Surgeons, they investigated continued diabetes remission (CDR) rates despite WR after RYGB compared to a sleeve gastrectomy (SG) cohort. The study included 224 RYGB and 46 SG patients.

The overall rate of CDR was significantly higher in the RYGB group (75%) compared to the SG group (34.8%) (p<0.001). The odds of T2DM recurrence were 5.5 times higher after SG compared to RYGB. Rates of CDR were stratified into WR quartiles (85.5%, <25%; 81.7%, 25-44.9%; 63.2%, 45-74.9% and 60%, >75%). Baseline insulin use, higher preoperative HbA1c and longer preoperative duration of T2DM were associated with T2DM recurrence, whereas WR was not.

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Comparison of health care costs following sleeve gastrectomy versus Roux-en-Y gastric bypass among patients with type 2 diabetes

Investigators from Harvard Medical School, Boston, MA, have reported patients with T2DM at baseline undergoing RYGB appear to experience a reduced need for ambulatory type 2 diabetes monitoring and reduced requirements for anti-diabetes medication but, did not experience an overall medical cost–benefit in the first few years after RYGB versus SG.

Writing in Obesity, the objective of this study was to compare the impact of SG and RYGB on overall and diabetes-specific health care costs among patients with type 2 diabetes. The matched study group included 9,608 patients who underwent SG or RYGB and were enrolled between 2007 and 2019. The primary outcomes assessed were overall and diabetes-specific health care costs.

They found that healthcare costs associated with T2DM declined substantially in the first few years following both SG and RYGB. RYGB was associated with a larger decrease in pharmacy costs, as well as type 2 diabetes-specific office and laboratory costs. SG was associated with lower total health care costs in the first three follow-up periods and lower acute care costs in the first two years after surgery.

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Safety and Efficacy of LSG Versus LRYGB on Patients with Obesity: a Systematic Review and Meta-analysis from RCTs

LRYGB is superior to LSG concerning short- and mid-term weight loss, short-term T2DM remission efficacy and related biochemical parameters, according to researchers from The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China, however, LSG is favoured because of fewer complications and shorter operating time.

Writing in Obesity Surgery, they compared the clinical efficacy and safety of LSG with LRYGB in terms of short- and mid-term outcomes of weight loss, obesity-related comorbidities, and post-operative complications via a meta-analysis of RCTs.

They identified 20 studies (1,270 patients) and the meta-analysis indicated the great superior efficacy of LRYGB to LSG in BMI loss at six (p=0.0003), 12 months (p=0.005) and 36 months (p=0.03) as well as %EWL gaining at 36 months.

At 12 months, LRYGB significantly higher remission rates of T2DM and dyslipidaemia were achieved, as well as better improvements for T2DM-related and lipid biochemical parameters. However, LSG resulted in a lower post-operative complication rate and shorter operating time.

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Laparoscopic Sleeve Gastrectomy vs One-Anastomosis Gastric Bypass 5 Years Follow-up: A Single-Blinded Randomized Controlled Trial

Researchers from Egypt and The Netherlands, have reported one-anastomosis gastric bypass (OAGB) had significantly higher weight loss (WL), less WR and less GERD, although it had a higher incidence of bile reflux vs. LSG.

Writing in the Journal of Gastrointestinal Surgery, this single-blinded, RCT was conducted to compare the outcomes of LSG and OAGB over a five follow-up and included 300 patients. In total, 201 patients (96 LSG and 105 OAGB) completed five years of follow-up.

OAGB had significantly higher %TWL and %EWL than LSG throughout follow-up, whereas LSG had significantly higher WR and GERD. Both procedures resulted in a significant improvement in associated medical problems and BAROS scores compared to baseline, with no significant differences.

WR was associated with higher relapse of associated medical conditions after initial remission and with lower BAROS scores regarding weight loss scores.

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Impact of Preoperative Weight Loss on 30-Day Complication Rate after Bariatric Surgery

US researchers have reported pre-operative WL does not lead to a consistent improvement in outcomes or operative times.

Reporting in Journal of the American College of Surgeons, they evaluated the impact of pre-operative WL on surgical outcomes and operative times after primary LSG and RYGB. The analysis included 171,010 patients.

For BMI<50, pre-operative weight loss led to no consistent improvement in surgical outcomes. While 0<-<5% TWL, led to a decrease in intra- and post- operative occurrences after RYGB, and a decrease in re-operation rates after LSG, these observations were not seen in those with higher degree of weight loss.

In BMI≥50, there may be improvement in select outcomes that is procedure specific, but overall, this data does not support a uniform policy of pre-operative weight loss, although selective use in some high-risk patients may be appropriate.

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Long-Term Brain Structure and Cognition Following Bariatric Surgery

Bariatric surgery is associated with improved cognition and general health and changed blood vessel efficiency and cortical thickness of the temporal cortex, according to researchers from The Netherlands.

Writing in JAMA Network Open, they investigate long-term associations of weight loss after surgery with cognition and brain structure and perfusion. In total, 133 took part in the study. They reported that global cognition was at least 20% higher in 52 participants (42.9%) at 24 months after surgery. Compared with baseline, at 24 months, inflammatory markers were lower, fewer patients used antihypertensives and patients had lower depressive symptoms and greater physical activity. After surgery, brain structure and perfusion were lower in most brain regions, while hippocampal and white matter volume remained stable.

These results may improve treatment options for patients with obesity and dementia, they concluded.

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