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Journal Watch 19/07/2023

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 latest Swedish Obese Subjects paper, LSG vs OAGB in adolescents, decreased risk of oesophageal adenocarcinoma post-RYGB, post-surgical thiamine deficiency in adolescents and LSG and non-responders, and more (please note, log-in maybe required to access the full paper).

Life expectancy after bariatric surgery or usual care in patients with or without baseline type 2 diabetes in Swedish Obese Subjects

Swedish researchers, writing in the International Journal of Obesity, have concluded that bariatric surgery is associated with similar reduction of overall and cardiovascular mortality and increased life expectancy regardless of baseline diabetes status.

The study included 2010 patients (gastric bypass (n = 265), banding (n = 376) or vertical banded gastroplasty (n = 1369) who were compared with a control group (n = 2037) who eligible for surgery by received usual obesity care.

In T2D and non-T2D subgroups, bariatric surgery was associated with increased life and reduced overall mortality. Bariatric surgery was associated with reduced cardiovascular mortality in both subgroups.

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Laparoscopic Sleeve Gastrectomy Versus One Anastomosis Gastric Bypass in Adolescents With Obesity

Both LSG and OAGB are effective and safe for weight loss in the adolescent population with OAGB associated with significantly fewer GI symptoms compared to LSG, according to a study by researchers from Tel Aviv University, Tel Aviv, Israel.

Published in the Journal of Pediatric Gastroenterology and Nutrition, the paper compared perioperative, early postoperative and one-year postoperative outcomes of adolescents who underwent LSG or OAGB surgery. They included were 75 adolescents (22 OAGB and 53 LSG).

They found a low rate of perioperative (5.7% vs 0) and postoperative complications (15.1% vs 10%) with no statistical differences between LSG and OAGB group. At 12 months, the percent excessive weight loss + IQR was 42.40% and 38.00% in the LSG and OAGB group, respectively (p=NS). The results of the Pediatric Quality of Life Inventory Gastrointestinal Symptoms scale revealed significantly less food limitation and heartburn after OAGB compared to LSG (p=0.03 and p=0.029, respectively).

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Decreased Risk of Esophageal Adenocarcinoma after Gastric Bypass Surgery in a Cohort Study from Three Nordic Countries

Scandinavian investigators have concluded gastric bypass surgery may counteract the development of esophageal adenocarcinoma (ECA) in morbidly obese individuals.

Writing in the Annals of Surgery, they compared the incidence of ECA between patients who had gastric bypass surgery (n=91,731, predominantly gastric bypass n=70,176; 76.5%) and non-surgical patients.

Among 748,932 participants with an obesity diagnosis, 91,731 underwent bariatric surgery, predominantly gastric bypass (n=70,176; 76.5%). The serious incidence rate (SIR) of ECA decreased over time following gastric bypass, from SIR=2.2 (95% CI 0.9-4.3) after 2-5 years to SIR=0.6 (95% CI <0.1-3.6) after 10-40 years. IN addition, gastric bypass patients were also at a decreased risk of ECA compared to non-operated patients with obesity, with decreasing point estimates over time.

There were no consistent associations between other bariatric procedures (mainly gastroplasty, gastric banding, sleeve gastrectomy, and biliopancreatic diversion) and ECA.

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Infrequent but serious? Thiamine deficiency among adolescents and young adults after bariatric surgery

In what is believed to be the first study to comprehensively assess thiamine deficiency (TD) among adolescents after bariatric surgery, researchers from Hamad Medical Corporation, Doha, Qatar, have found that although TD is uncommon among adolescents post-surgery, it is serious requiring diligent suspicion and prompt treatment.

They retrospectively reviewed 1,575 patients and seven 7 subsequently had TD, and another 23 adolescents who had surgery at private hospitals/overseas and presented at with TD.

Risk factors included poor oral intake (90%), nausea/vomiting (80%) and non-compliance to multivitamins (71%). Half the cases achieved complete resolution of symptoms, while 47% and 40% had residual weakness or persistent sensory symptoms respectively. The most common concurrent nutritional deficiencies were vitamins K, D, and A.

They concluded bariatric teams should emphasize on compliance with multivitamins and follow it up.

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Long-Term Outcomes of Sleeve Gastrectomy: Weight Recurrence and Surgical Non-responders

US researchers have reported that only 20% of patients who underwent SG and who were followed up for more than five years were able to maintain appropriate weight loss.

Writing in Obesity Surgery, they sought to report the rate of weight recurrence/non-responders (WR/NR) in patients who underwent SG and had more than five years of follow-up. This multi-centre retrospective study included 339 patients (78% female) who underwent initial SG from 2008 to 2017. Surgical non-responders were defined as 20% weight regain compared to maximum weight loss.

They found surgical non-response was noted in 15.9% of patients (n=54) and 64.0% (n=217) had weight recurrence after SG. There was a statistically significant difference in history of hypertension (p=0.046) and diabetes (p=0.032) as well as %TBWL at one year (p=0.005) and at longest follow-up (p<0.001) between patients who experienced WR/NR and those who did not.

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