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Journal Watch 19/05/2022

Updated: Jun 8, 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 study comparing single anastomosis sleeve jejunal (SASJ) with ileal (SASI) bypass, five-year outcomes from laparoscopic sleeve gastrectomy (LSG) with Rossetti fundoplication procedure, Banded RYGB superior to LSG on Diabetes Remission at five-years, tubularised and effaced gastric cardia mimicking Barrett Esophagus post-LSG, and periodontal health bariatric surgery patients (please note, log-in maybe required to access the full paper).

Optimal Length of Biliopancreatic Limb in Single Anastomosis Sleeve Gastrointestinal Bypass for Treatment of Severe Obesity: Efficacy and Concerns

Researchers from Shiraz University of Medical Sciences, Shiraz, Iran, writing in Obesity Surgery, who compared single anastomosis sleeve jejunal (SASJ) with ileal (SASI) bypass, have reported that both procedures achieved satisfactory weight loss and improvement in obesity-associated medical problems that were comparable between the two groups.

Their retrospective study was carried out with 162 patients. The main outcome measures were weight loss and improvement in obesity-associated medical problems, nutritional status, and complications at 12 months post-surgery.

At 12 months, both groups showed significant weight loss and remission in obesity-associated medical problems. There were significant differences in body mass index (BMI), total weight loss (TWL), and excess weight loss (EWL) between SASI and SASJ bypass (p<0.05). Improvements in associated medical problems after the two procedures were similar except for hypertension. The reversal surgery rate of the SASI group was significantly higher than that of the SASJ group (5.5% vs. 0.0%, p=0.03).

They noted that SASI bypass was followed by a significant difference in the rate of reversal surgery at one year due to a short common channel, which was not observed after SASJ bypass.

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Laparoscopic Sleeve Gastrectomy with Rossetti fundoplication. Long-term (5 years) follow-up

Investigators from the University of Milan Italy have found that laparoscopic sleeve gastrectomy (LSG) with Rossetti fundoplication procedure is well tolerated, feasible and safe in obese patients with adequate weight loss results and complete resolution of clinical signs of gastroesophageal reflux disease (GERD), at five years.

In total, over 450 obese patients underwent LSG and Rossetti fundoplication performed by four different expert bariatric surgeons. The paper reported the outcomes on 127 patients who have follow-up of 5 years or more.

In total, 74.8% patients were suffering from GERD before surgery: In 29/127 cases (22.8%), preoperative gastroscopy had shown signs of esophagitis and/or Barrett. In particular: 23/127 (18.1%) grade A esophagitis; 2/127 (1.6%) grade B; 2/127 (1.6%) grade C; 2/127 (1.6%) Barrett's esophagitis. There were no intraoperative complications or conversion were reported. Regular postoperative course in 91.3% of patients.

They report in SOARD that 60 months after surgery, more than 95% of patients do not suffer from reflux symptoms. %total weight loss (%TWL) at follow-up were comparable with LSG. Endoscopic follow-up demonstrated improvement of esophagitis lesions (including Barrett's esophagus) present in the preoperative setting.

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Effect of Banded Roux-en-Y Gastric Bypass Versus Sleeve Gastrectomy on Diabetes Remission at 5 Years Among Patients With Obesity and Type 2 Diabetes: A Blinded Randomized Clinical Trial Rinki

Writing in Diabetes Care, New Zealand researchers find that silastic ring laparoscopic Roux-en-Y gastric bypass (SR-LRYGB) had superior diabetes remission and weight loss compared with LSG at five years, with similar low risks of complications.

In their single-centre, double-blind trial, 114 adults with type 2 diabetes and BMI 35–65 kg/m2 were randomly assigned to SR-LRYGB or LSG (1:1; stratified by age-group, BMI group, ethnicity, diabetes duration, and insulin therapy). The primary outcome was diabetes remission assessed at five years, defined by HbA1c <6% (42 mmol/mol) without glucose-lowering medications. Secondary outcomes included changes in weight, cardiometabolic risk factors, quality of life and adverse events.

Diabetes remission after SR-LRYGB versus LSG occurred in 25 (47%) of 53 vs. 18 (33%) of 55 patients (p=0.009) and 4.2 (p=0.015) in the intention-to-treat analysis). Percent body weight loss was greater after SR-LRYGB than after LSG (p<0.001). Improvements in cardiometabolic risk factors were similar, but HDL cholesterol increased more after SR-LRYGB. Early and late complications were similar in both groups. General health and physical functioning improved after both types of surgery, with greater improvement in physical functioning after SR-LRYGB. People of Māori or Pacific ethnicity (26%) had lower incidence of diabetes remission than those of New Zealand European or other ethnicities (2 of 25 vs. 41 of 83, p<0.001).

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Tubularized and Effaced Gastric Cardia Mimicking Barrett Esophagus following Sleeve Gastrectomy Protocolized Endoscopic and Histological Assessment with High-Resolution Manometry Analysis

Australian authors writing in the Annals of Surgery have found that the novel appearance of tubularised cardia telescoping supra-diaphragmatically with flattening of gastric folds is common post-LSG, likely associated with isobaric hyper-pressurization of proximal stomach.

Their paper sought to describe expected endoscopic and histological changes at gastro-esophageal junction (GEJ) and define diagnostic paradigms for Barrett esophagus (BE) post-sleeve gastrectomy (SG).

Firstly, they evaluating endoscopic changes of GEJ post-SG (n=567) compared to pre-SG (n=320), utilising protocolised pre-operative screening, post-operative surveillance and synoptic reporting. They then looked at the causes of altered anatomical and mucosal GEJ appearance using histopathology (n=55) and high-resolution manometry (HRM) (n=15).

They found that characteristic tubularised cardia segment projecting supra-diaphragmatically was identified and almost exclusive to post-SG (0.6%vs.26.6%, p<0.001). True BE prevalence was low (4.1%pre-SG vs. 3.8% post-SG, p=0.756), esophagitis was comparable (32.1%vs.25.9%, p=0.056).

The authors said the findings provide a clear framework for approaching endoscopic screening and surveillance, with correct anatomical and mucosal identifications, and clarified key issues of SG and BE.

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Periodontal and systemic health of morbidly obese patients eligible for bariatric surgery: a cross-sectional study

Researcher from the University Medical Centre Ljubljana, Ljubljana, Slovenia, has found patients with morbid obesity eligible for bariatric surgery show a high prevalence of periodontitis and, therefore, are advised to be examined by a dentist before undergoing surgery.

Writing in BMC Oral Health, the study aimed to evaluate the periodontal status of these patients eligible for bariatric surgery and the association between periodontitis, obesity-related comorbidities and Edmonton obesity staging system (EOSS).

In total, 79 patients eligible for bariatric surgery underwent detailed periodontal examination and were divided into the periodontitis group (PG) and the non-periodontitis group (NPG). The prevalence of periodontitis was 65% (CI 95% 53%-75%). PG patients (n=51) were older, more often smokers and were more often hypertensive than NPG patients (n=28) (p<0.05). Hypertension was positively associated with periodontitis (p=0.021) and age (p=0.038)), while other tested conditions (diabetes, dyslipidaemia and smoking habits) did not show significant association with periodontitis. Periodontitis did not correlate with EOSS or other obesity-related comorbidities (p>0.05).

The authors concluded that medical personnel should raise awareness among obese patients on the potential association of poor periodontal health with hypertension.

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