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Journal Watch 17/1/2024

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 surgery and the risk of multiple myeloma, ACA increased RYGB in the US, conversion of RYGB to BPD-DS can be performed in one-stage, TORe after RYGB failure and once-weekly semaglutide administered post-LSG, and more (please note, log-in maybe required to access the full paper).

Correlation Between Bariatric Surgery and the Risk of Multiple Myeloma: Results from an Evidence-Based Strategy

The outcomes from a meta-analysis suggest a reduced risk of multiple myeloma in patients with obesity following bariatric surgery, according to researchers form Gansu University of Chinese Medicine, Lanzhou, China.

Reporting in Obesity Surgery, their meta-analysis examined whether bariatric surgery (BS) had a positive effect on reducing the risk of multiple myeloma (MM) and included ten studies with 2,452,503 patients with obesity.

The outcomes revealed a significant reduction in the risk of MM in patients with obesity after bariatric surgery vs. non-surgical patients with obesity (RR = 0.51, 95%CI: 0.31–0.84). A subgroup analyses showed a decreased probability of developing MM in European patients with obesity and North American patients with obesity who underwent bariatric surgery.

In addition, studies with a sample size greater than or equal to 100,000 indicated a significantly reduced risk of MM in patients with obesity undergoing bariatric surgery vs. the non-surgical group (p<0.02). Two publications prior to 2010 showed no significant difference in the incidence of MM between the surgical and non-surgical groups (p=0.504), compared with publications after 2010 that showed a reduced incidence in the surgical group (p=0.012).

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Utilization and Outcomes of Roux-en-Y Gastric Bypass Surgery Following the Affordable Care Act in the United States

The utilisation of Roux-en-Y Gastric Bypass (RYGB) significantly increased after the implementation of the Affordable Care Act (ACA), especially among Black patients, Medicaid beneficiaries, and low-income patients, researchers from Howard University College of Medicine, Washington DC, have reported.

Writing in the journal American Surgeon, the study’s authors used data from the National Inpatient Sample (NIS) Database, and compared the pre-ACA period (2007-2009) with the post-ACA period (2017-2019). In the study periods, there were 158,186 RYGB performed (30.0% in pre-ACA and 70.0% in the post-ACA).

In the post-ACA period, the proportion of uninsured patients decreased from 4.8% to 3.6% (p<0.05), while Black patients increased from 12.5% to 18.5% (p<0.05). Medicaid-insured patients increased from 6.8% to 18.1% (p<0.05), while patients in the poorest income quartile increased from 20% to 26% (p<0.05). Interestingly, patients in the post-ACA period were less likely to have longer hospital stays (p<0.01), in-hospital mortality (p<0.01), surgical site infection (p<0.01), postop haemorrhage (p<0.01) and anastomotic leak (p<0.01) than those in the pre-ACA period.

Importantly, despite the inclusion of more high-risk surgical patients in the post-ACA period, there were better outcomes after surgery, the researchers noted.

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Long-term results of conversion of Roux-en-Y to biliopancreatic diversion with duodenal switch

Researchers from the Clinique de l’Anjou, Angers, France, have reported that conversion of RYGB to biliopancreatic diversion with duodenal switch (BPD-DS) can be performed in one-stage although the use of an unconventional technique could not reduce the high complication rate, despite its complexity.

Reporting in SOARD, they retrospectively assess the early outcomes and up to ten-year weight results of the conversion of RYGB to BPD-DS from a French private hospital. An analysis was conducted on patients who had conversion of RYGB to BPD-DS performed since 2010 for a percentage of excess weight loss (%EWL) <50% with a small gastric pouch.

In total, 74 patients (65 women and 9 men) were included in the study and conversion was always performed in one stage and laparoscopically for 93% of the patients. The 30-day complication rate was 25.7% with 14.8% of the patients re-operated on. Maximum results were seen two years after conversion outranging RYGB: %EWL of 78.3 ± 24% with %TWL of 35.9 ± 11.9% and %EWL of 72 ± 24.1% with %TWL of 32.6 ± 11% respectively.

The 5-year weight of all the patients (85.7% follow-up) remained lower than the pre-conversion one. Over-time 1 reversal and 4 revisions were required and frequent stools, gastroesophageal reflux the most frequent complaints.

They concluded that BPD-DS remains an efficient procedure after RYGB in selected patients, comparable to distalisation of RYGB which can be less risky.

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Prospective evaluation of transoral outlet reduction (TORe) after Roux-en-Y gastric bypass (RYGB) failure

Transoral outlet reduction (TORe) procedure with nutritional management results in significantly higher %EWL at 12 months compared to patients with nutritional management alone after RYGBP failure linked to the dilatation of the gastro-jejunal anastomosis, French researchers have reported in Surgical Endoscopy.

This prospective, multicentre, simple blind, randomised study included 73 subjects who were randomized in four French Bariatric centres. The final analysis involved 50 subjects, 25 in each group, 44 women, 6 men, with an average BMI40.6kg/m2. At 12 months, the average %EWL was significantly higher in the TORe group than in the Sham group (13.5 ± 14.1 vs. − 0.77 ± 17.1; p=0.002).

They found no significant difference between groups concerning the improvement of obesity-related comorbidities (diabetes and dyslipidaemia) and quality of life at 12 months. They report 20% of patients had adverse events related to the TORe procedure. Three adverse events were serious, including two perforations of the gastro-jejunal anastomosis after TORe group that led to the premature termination of the study.

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Once-weekly semaglutide administered after laparoscopic sleeve gastrectomy: Effects on body weight, glycemic control, and measured nutritional metrics in Japanese patients having both obesity and type 2 diabetes

Semaglutide after laparoscopic sleeve gastrectomy (LSG) in patients with obesity and T2D resulted in additional weight reduction and improved glycaemic control, but worsened measured nutritional metrics, according to a study by researchers from Japan.

Writing in Obesity Pillars, the study investigated the effect of treatment with once-weekly semaglutide post-LSG laparoscopic sleeve gastrectomy (LSG) in T2DM patients, as well as assessing the effects of combined use with a low-energy, high-protein formula diet (FD). In total, 29 Japanese patients with T2DM who underwent LSG, and more than 12 months later received semaglutide. The patients were divided retrospectively into a FD group (=6) and a conventional diet (CD) group (n=23).

They found that BMI and HbA1c decreased significantly by 10.7kg/m2 and 1.1 %, respectively, 12 months after LSG, and decreased by an additional 1.6kg/m2 and 0.6% after 12-months of treatment with semaglutide. They also reported that decreases in serum albumin, vitamin B12 and zinc were observed only after semaglutide administration. The FD group showed a significant increase in skeletal muscle mass per 1 % body weight vs. CD group during semaglutide treatment.

The researchers added that the administration of a low-energy, high protein formula diet may ameliorate adverse nutritional effects of semaglutide in patients with T2D after LSG.

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