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Journal Watch 19/06/2024

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 the AGREE framework, long term banded vs non-banded RYGB outcomes, Berlin questionnaire outperforms STOP-Bang in predicting OSA, BASALTO trial outcomes of concomitant AOMs use with ESG, and more (please note, log-in maybe required to access the full paper).

Assessment of guidelines for bariatric and metabolic surgery: a systematic review and evaluation using appraisal of guidelines for research and evaluation II (AGREE II)

Researchers from Canada who assessed bariatric clinical practice guidelines using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) framework, have concluded many do not adequately seek patient input, state search criteria, use evidence rating tools and consider resource implications.

Reporting in the International Journal of Obesity, their literature search identify 26 articles and the overall median domain scores for guidelines were: (1) scope and purpose: 87.5% (2) stakeholder involvement: 49%, (3) rigor of development: 42.5%, (4) clarity of presentation: 85% (5) applicability: 6% (6) editorial independence: 50% (IQR: 48–67%), (7) overall impressions: 48%. However, only six guidelines achieved an overall score >70%.

They concluded that future guidelines should reference the AGREE II framework in study design.

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Long-term Comparative Evaluation of Weight Loss and Complications of Banded and Non-banded Roux-en-Y Gastric Bypass

Banded RYGB results in significantly higher rates of % total weight loss (%TWL) but has a higher frequency of food intolerance and vomiting vs. non-banded RYGB, according to researcher from the University of São Paulo, Ribeirao Preto, Brazil.

Writing in Obesity Surgery, the primary objective of this study was to evaluate banded and non-banded RYGB regarding %TWL and complications up to ten years postoperatively and regarding the removal rate of the silicone band.

In total, 858 patients (banded RYGB and 449 underwent non-banded RYGB) were included in the study. The %TWL was higher in the banded RYGB group up to seven years. The prevalence of vomiting is much higher in this group, which also had lower laboratory test values. Of the banded RYGB patients, 9.53% had to have the silicone ring removed after presenting complications.

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Identifying the optimal STOP-Bang screening score for obstructive sleep apnea among bariatric surgery patients

The Berlin questionnaire outperforms STOP-Bang in predicting obstructive sleep apnoea (OSA) requiring treatment, researchers from the Medical College of Wisconsin, Milwaukee, WI, have reported.

Writing in SOARD, they sought to determine the ideal OSA screening tool for bariatric surgery patients balancing accuracy and cost-effectiveness. They compared STOP-Bang score and the Berlin Score.

From 484 patients who underwent bariatric surgery, 167 (34.5%) had a STOP-Bang score ≥4. The receiver operating characteristic (ROC) curve for STOP-Bang scores ≥4 had an area under the curve (AUC) of 78.5% for predicting OSA and 83.7% for OSA requiring treatment (AHI ≥ 15), compared to Berlin Scores’ AUC of 80.7% and 88.6%, respectively. A STOP-Bang score of 4 had a sensitivity of 55.6% and specificity of 36.8%, while a score of 5 had 29.3% and 66.2%, respectively. A Berlin score of 3 had a sensitivity of 47.5% and specificity of 69.1%, with 30 patients (44.1%) starting OSA treatment.

Raising the polysomnography referral score from STOP-Bang ≥4 to ≥5 or utilizing a Berlin score of ≥3, may alleviate resource burden, reduce costs and expedite medical optimization for bariatric surgery, they concluded.

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Short-term effects of gastric bypass versus sleeve gastrectomy on high LDL cholesterol: The BASALTO randomized clinical trial

Roux-en-Y gastric bypass (RYGB) is superior to laparoscopic sleeve gastrectomy in terms of short-term of high low-density lipoprotein (LDL) cholesterol, according to Spanish researchers.

Writing in Cardiovascular Diabetology, this single-centre, randomised clinical trial using intention-to-treat analysis, 38 patients with severe obesity and elevated levels of LDL cholesterol were randomly assigned to undergo RYGB or SG. The primary outcome was LDL cholesterol remission at 12 months, defined as LDL cholesterol < 3.36 nmol/l without lipid-lowering medications.

Intention-to-treat analysis revealed that LDL cholesterol remission occurred in 66.6% of RYGB patients, compared to 27.8% of SG patients (p=0.019). Among patients completing follow-up, RYGB demonstrated superior remission (80.0% vs. 29.4%, p=0.005). Exclusive benefits of RYGB included a reduction in large, medium, and small LDL particles. There were no differences in weight loss, cholesterol esters, glycoproteins, cholesterol synthesis metabolites or postoperative complications observed between techniques.

RYGB also led to a greater improvement in lipoprotein parameters that confer an atherogenic profile. They cautioned that the presence of elevated levels of LDL cholesterol should be considered when determining the optimal bariatric surgery procedure for each patient.

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Outcomes of concomitant antiobesity medication use with endoscopic sleeve gastroplasty in clinical US settings

A US study that evaluated the weight loss outcomes of the large US cohort of patients undergoing endoscopic sleeve gastroplasty (ESG) with or without concomitant anti-obesity (AOM) use, has found the use of pharmacotherapy at the appropriate time, patients can achieve optimal results.

Writing in Obesity Pillars, total of 1506 patients were included (1359 (90.2 %) no AOM use and 147 (9.8 %) AOM use). Patients who were on an active AOM at the time of the procedure had a significantly lower TBWL% vs. patients not on AOMs at six months. At the 24-month visit, patients who were prescribed AOMs after the 12-month visit had a significantly higher TBWL% and EWL% vs. patients who were on active AOM at the time of the procedure.

There was no significant difference between classes of medications at any time point, however, patients on a GLP-1RA had a trend towards improved weight loss at 18 and 24 months.

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