Journal watch 19/11/2025

Welcome to our regular 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 long-term outcomes of RYGB vs SG, gallstone formation post RYGB and SG, combination of OAGB with modified fundoplication improves GERD-HRQL score, Brazilian experts publish guideline on the management of obesity and prevention of CVD and obesity-associated complications, and more (please note, log-in maybe required to access the full paper).

Evaluating the Effectiveness and Long-term Outcomes of Roux-en-Y Gastric Bypass vs Gastric Sleeve Bariatric Surgery in Obese and Diabetic Patients: Systematic Review

Researchers from Saint James School of Medicine, Chicago, IL, have reported that RYGB produces superior weight loss and metabolic outcomes, whereas SG presents a safer overall profile.

Published in the Journal of the American College of Surgeons, this systematic review compared long-term outcomes of RYGB and SG in patients with obesity and T2DM, emphasising sustained weight loss, T2DM remission, revisional surgery, and postoperative complications, including GERD, Barrett’s oesophagus, and anastomotic leak.

They reported RYGB was associated with more significant long-term weight loss and superior T2DM remission rates. SG had a lower risk of nutritional deficiencies with increased risk of complications requiring surgical revision, particularly GERD, which may progress to Barrett’s oesophagus and increase oesophageal cancer risk. Revisional surgery occurs frequently post-SG surgery due to weight recurrence and treatment-resistant GERD. In contrast, RYGB revisions were more often due to marginal ulcers and strictures.

“The surgical selection process should be individualised on the basis of comorbidities, T2DM duration, and ongoing postoperative monitoring needs,” they concluded.

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Comparative Risk of Gallstone Formation After Sleeve Gastrectomy and Roux-En-Y Gastric Bypass: A Systematic Review and Meta-Analysis

Researchers from Antenor Orrego Private University, Trujillo, Peru, have found SG is associated with a lower short-term risk of gallstone formation compared with RYGB, although results are heterogeneous and sensitive to study weight.

Published in Obesity Surgery, the researchers compared the risk of gallstone formation after SG and RYGB. Their review identified ten studies (n=195,665) met inclusion criteria. Overall, SG was associated with a lower risk of gallstone formation than RYGB (p=0.003). The protective association was evident in studies with < 2 years of follow-up but not in ≥ 2-year follow-up.

They concluded that standardised outcome definitions, longer follow-up, and stratification by UDCA use are needed to refine comparative risk estimates.

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Quality of Life Outcomes After Fundoplication-Augmented One-Anastomosis Gastric Bypass: A Randomized Comparative Study

Compared with OAGB alone, the combination of OAGB with modified fundoplication offers a distinct advantage in terms of quality of life, as evidenced by improved symptom scores, decreased reliance on proton pump inhibitors, and enhanced endoscopic and manometric control of reflux, according to researchers from Homerton University Hospital, London, and Ain Shams University, Cairo.

Published in Cureus, this study assessed whether the incorporation of a modified fundoplication could enhance symptom control and health-related quality of life (HRQoL) compared with OAGB alone.

A prospective randomized comparative study was conducted involving 60 patients diagnosed with obesity and GERD. Participants were randomly allocated into two groups for a follow-up period of two years: Group A underwent OAGB only, and Group B received OAGB with modified fundoplication.

In comparison to OAGB alone, fundoplication demonstrated superior symptom control (p=0.001) and resulted in a shorter duration of PPI use (p=0.001). The GERD-HRQL scores showed significant improvement following fundoplication at six months (48.33 ± 7.91 to 31.57 ± 3.90; p<0.001), and this improvement was sustained up to 24 months, whereas the changes observed after OAGB alone were not statistically significant. At the 24-month mark, endoscopic evaluation revealed an intact wrap with no evidence of GERD, and manometry confirmed restoration of LES function.

“This integrated approach represents a viable strategy for optimizing the HRQoL of patients with obesity and GERD. However, validation through larger multi-centre studies with extended follow-up periods and pH impedance monitoring is necessary,” they concluded.

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Impact of Bariatric Surgery on Prostate Cancer Screening Rate

Following bariatric surgery, patients became the most screened group for prostate cancer, suggesting surgery serves as an impetus for engaging with the healthcare system across other areas of care, researchers from the University of Utah, Salt Lake City, Utah, have reported.

Published in Journal of the American College of Surgeons, the study 13,662 males aged 50 to 65 years in the US who underwent bariatric surgery were identified and compared to three control groups who did not undergo bariatric surgery stratified by obesity diagnosis according to ICD codes.

For surgical patients, rate of screening prior to bariatric surgery was 0.07 tests per person-year and improved to 0.17 tests per person-year following surgery (p<0.001). For control groups, screening rates were 0.08, 0.13, and 0.11 tests per person-year for patients with no obesity, patients with obesity, and those with morbid obesity, respectively. The incidence rate ratio relative to the no obesity control group was 1.03 for the pre-surgery group, 2.35 for the post-surgery group, 1.66 and 1.54 for the obesity and morbid obesity groups, respectively.

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2025 Brazilian evidence-based guideline on the management of obesity and prevention of cardiovascular disease and obesity-associated complications: a position statement by five medical societies

Researchers from Brazil have published guidelines offering a practical, evidence-based framework for the treatment of obesity, primarily focusing on the prevention of obesity-related complications, particularly CVD.

Published in Diabetology & Metabolic Syndrome, the guidance was developed through a collaboration among five leading Brazilian medical societies (Brazilian Association for the Study of Obesity and Metabolic Syndrome, Brazilian Diabetes Society, Brazilian Society of Endocrinology and Metabolism, Brazilian Cardiology Society, and Brazilian Sleep Academy), aimed to structure obesity treatment within the context of CVD prevention, considering both cardiovascular risk and obesity stage.

Following cardiovascular risk assessment using the Predicting Risk of CVD Events risk score, individuals with obesity or overweight should be stratified according to their ten-year risk of developing atherosclerotic disease (low, moderate, or high) and heart failure (high-risk). Anti-obesity treatment should then be guided by the best evidence-based recommendations designed to address excess adiposity and reduce associated complications.

“By applying these recommendations, healthcare professionals can tailor therapeutic strategies to the specific needs of individuals living with obesity. We hope that the widespread implementation of this guideline will contribute to reducing the adverse health burden of obesity and CVD, improving public health outcomes in Brazil,” they concluded.

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