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Journal watch 17/11/2021

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 comparison of OAGB, RYGB, and SG, an outline from the French Bougie Sleeve Trial (BOUST), the relationship between gastric wall thickness and linear staple height, outcomes from a trial assessing the Spatz3 adjustable intragastric balloon and a paper reporting that obesity is associated with increasing the risk of colorectal cancer (please note, log-in maybe required to access the full paper).

Comparison of Short-term Safety of One Anastomosis Gastric Bypass to Roux-en-Y Gastric Bypass and Sleeve Gastrectomy in the United States: 314 cases from MBSAQIP-accredited Centers

Writing in SOARD, researchers from the US have reported that the short-term safety profile of primary one anastomosis gastric bypass (OAGB) is acceptable, but future studies should determine the long-term safety.

The researchers investigated the short-term safety outcomes of the three primary bariatric procedures - laparoscopic OAGB, RYGB, and SG. The primary outcome was 30-day overall complication and secondary outcomes were 30-day surgical and medical complications and hospitalization length. They examined data from the MBSAQIP database.

They found that OAGB patients had a lower overall complication rate than RYGB patients (6.7% v. 12.3%, p=0.02) and a similar rate to the SG cohort (v. 5.0%, p=0.43). The OAGB cohort had a similar rate of surgical complication to the RYGB cohort (5.0% v. 8.5%, p=0.1) and a higher rate than the SG group (1.2%, p=0.009).

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Impact of the calibration bougie diametre during laparoscopic sleeve gastrectomy on the rate of postoperative staple-line leak (BOUST): study protocol for a multicentre randomized prospective trial

Investigators from France are examining whether the diameter of a calibration bougie could impact the rate of postoperative gastric leak following laparoscopic sleeve gastrectomy (LSG). The Bougie Sleeve Trial (BOUST) is a superiority single-blinded randomised trial, involving 17 centres.

Participants will be randomised into two groups – one using 48-Fr diameter calibration and 34 to 38-Fr diameter (standard care) calibration bougie. Both groups will take part in a two-year post-operative follow-up to assess postoperative gastric leak rate and weight loss and quality of life evolution.

Writing in BMC Trials, the authors noted that this is the first randomised trial to compare the outcomes of LSG regarding the use of two different bougie diameters on postoperative gastric leak and mid-term weight loss.

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Gastric Wall Thickness and Linear Staple Height in Sleeve Gastrectomy in Japanese Patients with Obesity

Researchers from Japan have reported that a light body weight may be related to the optimal size of linear staplers in relation to gastric wall thickness (GWT) during laparoscopic sleeve gastrectomy (LSG) procedures.

Between August 2016 and December 2020, the researchers performed LSG in 70 patients with an average age, body weight and body mass index of 42 years, 107 kg, and 40 kg/m2, respectively. They measured the GWT at the antrum, body and fundus using resected specimens, and used an endo-linear stapler with a closed staple height (CSH) of 1.75 mm.

Writing in Obesity Surgery, they found that the average GWT at the antrum was significantly thicker than the GWT at the body and fundus. There was a statistically significant relationship between body weight and the GWT at the antrum and body and obstructive sleep apnoea and the GWT at the body. The average CSH/GWT ratios were 0.55, 0.62, and 0.90 at the antrum, body, and fundus, respectively. However, in 20 patients (29%), the CSH/GWT ratio at the fundus area was ≥ 1.0, and only preoperative body weight was a significant predictor for a CSH/GWT ratio of ≥ 1.0.

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Adjustable intragastric balloon for treatment of obesity: a multicentre, open-label, randomised clinical trial

US researchers have reported the outcomes from a trial assessing the safety and efficacy of an adjustable intragastric balloon (aIGB) - Spatz3 Gastric Balloon, the first adjustable gastric balloon system.

The study included 288 patients to aIGB (n=187) or control (n=101) groups. Mean total bodyweight loss at 32 weeks was 15.0% in the aIGB group versus 3.3% in the control group (p<0.0001). Adjustments to the aIGB occurred in 145 (80%) patients for weight loss plateau or intolerance. Upward volume adjustment facilitated an additional mean 5.2% total bodyweight loss and downward volume adjustment allowed 21 (75%) patients in the aIGB group to complete the full duration of therapy. Intolerance caused early removal of the device in 31 (17%) patients. Device-related serious adverse events were observed in seven (4%) patients, without any deaths.

They concluded in The Lancet that when aIGB was combined with lifestyle modification, significant weight loss was achieved and maintained for six months following removal.

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Obesity and Roux-en-Y gastric bypass drive changes in miR-31 and miR-215 expression in the human rectal mucosa

UK researchers have reported that obesity is associated with dysregulated microRNA expression in the human rectal mucosa, increasing the risk of colorectal cancer (CRC), and bariatric surgery could reduce the risk. For the study, published in the International Journal of Obesity, they examined the effects of obesity and weight loss following Roux-en-Y gastric bypass (RYGB) on microRNA expression in the human rectal mucosa.

They found that compared with non-obese individuals, obese individuals showed differential expression of 112 microRNAs (p < 0.05). At six-months post-RYGB, when mean body mass had fallen by 27kg, 60 microRNAs were differentially expressed, compared with baseline (p < 0.05). Weight loss, following RYGB, reduced expression of miR-31 and miR-215 to levels comparable with controls. These differentially expressed microRNAs are implicated in pathways linked with inflammation, obesity and cancer.

Their findings show that obesity is associated with dysregulated microRNA expression in the human rectal mucosa and surgically-induced weight loss may normalise microRNA expression in this tissue.

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