Journal watch 16/03/2022

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 a single centre study examining rates of gastroesophageal reflux disease and hiatal hernia after laparoscopic sleeve gastrectomy, Canadian researchers have characterised the preoperative factors and outcomes of patients undergoing intragastric balloon (IGB) therapy compared to bariatric surgery, investigators from Imperial College London, UK, have outlined patient awareness, views and priorities for outcome reporting in bariatric surgery and provided recommendations for future surgeon-specific outcome reporting (SSOR), a systematic review and meta-analysis carried out by Australian researchers has determined the relative lean mass and fat mass changes in adults with obesity following bariatric surgery, and an international team of researchers have assessed the potential differences between subjects with prediabetes or T2DM and healthy controls in Soluble suppression of tumorigenesis-2 and galectin (Gal)-3 circulating levels (please note, log-in maybe required to access the full paper).


Gastroesophageal Reflux Disease and Hiatal Hernia After Laparoscopic Sleeve Gastrectomy: A Retrospective Cohort Study

Approximately one-third of the patients developed gastroesophageal reflux disease (GERD) up to two years after laparoscopic sleeve gastrectomy (LSG), although the incidence of hiatal hernia after bariatric surgery was low, according to researchers from Saudi Arabia.


A total of 142 patients were included in the study, the post-operative new-onset GERD was observed in 47 (33.1%) patients. The average time for the development of GERD was six months, and most cases presented three months after the procedure. Post-operative hiatal hernia was observed in five (3.5%) patients. It was significantly associated with GERD (p=0.007).


They recommended offering consultation for patients with identified risk factors about the risk of having GERD and the need for alternative methods to lose weight, such as LRYGB.


They said that future randomized and multi-centre trials are needed to improve the understanding of the anatomic and pathophysiological mechanisms to put an end to this debate and to delineate the risk factor associated with GERD development after LSG. The paper was published in published in Cureus.


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Trends in the Utilization of Intragastric Balloons: a 5-Year Analysis of the MBSAQIP Registry

Canadian researchers have characterised the preoperative factors and outcomes of patients undergoing intragastric balloon (IGB) therapy compared to bariatric surgery (non-IGB) and evaluated five-year trends in IGB use. The study was published in Obesity Surgery

A retrospective cohort study was performed by extracting data from the MBSAQIP registry between 2015 and 2019. All non-IGB and IGB procedures were included while revisional and emergency surgeries were excluded.


Of 652,927 patients identified, a total of 2,910 (0.4%) underwent IGB therapy. Patients who underwent IGB therapy were older (p<0.0001), had lower BMI at baseline (<0.0001), and were overall healthier with fewer comorbidities and better functional status. The rate of early nonoperative reintervention was higher in the IGB cohort (7.7% vs 1.1%; p<0.0001). Age was the only significant predictor of selection for IGB therapy (p<0.0001). The number of IGB procedures reported between 2016 and 2019 declined significantly (953 (0.62%) vs 418 (0.25%); p<0.0001).

The ongoing role of IGBs in the treatment of obesity is unclear given the safety and efficacy of modern bariatric surgery and new pharmacological agents for weight loss, the authors concluded.


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Patient Perspectives On Surgeon-Specific Outcome Reports In Bariatric Surgery

Investigators from Imperial College London, UK, have outlined patient awareness, views and priorities for outcome reporting in bariatric surgery and provided recommendations for future surgeon-specific outcome reporting (SSOR) through the United Kingdom National Bariatric Surgery Registry. The findings were reported in SOARD.


They adapted a previously validated questionnaire and surveyed the views of 150 patients in a single bariatric surgical unit. Seventy three percent of participants were unaware they could access SSOR. Of the participants that were unaware, 75% stated that they would have accessed SSOR had they been aware they could. Of the participants that had previously accessed SSOR, 61% indicated it did not influence their choice of surgeon. The majority of participants favoured public release of outcome reports at the surgeon-level (75%) and hospital-level (83%). The three main priorities indicated by participants for future outcome reporting were complication rates (91%), patient reported outcome measures (90%) and reoperation rate (89%), all at the surgeon-level.


They concluded that patient awareness of outcome reporting is poor and efforts must be made to increase awareness of SSOR. Patients should be incorporated as key stakeholders in determining future outcome reporting in bariatric surgery.


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Body composition changes at 12 months following different surgical weight loss interventions in adults with obesity: A systematic review and meta-analysis of randomized control trials

A systematic review and meta-analysis carried out by Australian researchers has determined the relative lean mass and fat mass changes in adults with obesity following bariatric surgery. Six RCTs were eligible for inclusion, with data extracted at 12 months post-surgery.


Meta-analysis revealed that, relative to gastric banding, Roux-en-Y gastric bypass (RYGB) led to greater total body mass loss and greater fat mass loss, but similar lean mass loss. RYGB also led to similar changes in total body mass, fat mass, and lean mass compared with sleeve gastrectomy. RYGB results in greater 12-month weight and fat loss, but similar changes in lean mass, compared with gastric banding.


They concluded that further RCTs comparing body composition changes following different bariatric surgery procedures are required. The study was published in Obesity Reviews.


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Effects of liraglutide vs. lifestyle changes on soluble suppression of tumorigenesis-2 (sST2) and galectin-3 in obese subjects with prediabetes or type 2 diabetes after comparable weight loss

International team of researchers have assessed (I) potential differences between subjects with prediabetes or type 2 diabetes mellitus (T2DM) and healthy controls in Soluble suppression of tumorigenesis-2 (sST2) and galectin (Gal)-3 circulating levels, and their relationship with glycaemic control and markers of beta cell function and myocardial injury; (II) whether liraglutide treatment modulates these markers in subjects with prediabetes or early T2DM independently of weight loss; (III) whether baseline levels of any of these two molecules may predict the response to liraglutide treatment.


Forty metformin-treated patients with obesity (BMI ≥ 30) with prediabetes [impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) or both (n = 23)] or newly diagnosed T2DM (n = 17), were randomised to liraglutide or lifestyle counselling until achieving a comparable weight loss (7% of initial body weight). Thirteen subjects were enrolled as healthy controls for baseline sST2 and Gal-3 levels.


Baseline sST2 levels were comparable between controls and obese patients (p = 0.79) whereas Gal-3 levels were significantly higher in patients as compared to controls (p < 0.001). Liraglutide treatment, but not weight loss achieved by lifestyle counselling, decreased plasma sST2 levels (p=0.037) while Gal-3 levels did not change. A reduction in serum hs-Troponin I was observed after intervention, due to a 19% (p=0.29) increase in the lifestyle arm, and a 25% decrease (p=0.033) in the liraglutide arm (between-group difference p=0.083). Lower baseline Gal-3 levels predicted a better improvement in beta cell function after liraglutide treatment.


Liraglutide-induced reduction in sST2 and possibly hs-TnI suggesting that in patients with obesity and prediabetes or early T2DM, this drug may have a positive effect on (cardiac) fibrosis, whereas plasma level of Gal-3 before liraglutide initiation may predict response to the drug in terms of beta cell function improvement. The findings were published in Cardiovascular Diabetology.


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