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Journal Watch 20/3/2024

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 anti-reflux suture on GERD post-OAGB, MBSAQIP analysis of marginal ulcers, GLP1-RA for post-surgical weight loss, impact of surgery on PCOS, surgery reduces cancer incidence, pre-surgical capsule-based pH testing could identify GERD, deep neuromuscular block during LSG aid pain relief and QoL scores, and more (please note, log-in maybe required to access the full paper).

Effect of anti-reflux suture on gastroesophageal reflux symptoms after one anastomosis gastric bypass: a randomized controlled trial

Gastroesophageal reflux disease (GERD) symptoms and de novo GERD after one anastomosis gastric bypass (OAGB) seems to be under-reported after OAGB, according to researchers from Iran.


Writing in Surgical Endoscopy, they compared the efficacy of the anti-reflux mechanism (anti-reflux suture) to treat pre-operative GERD and prevent de novo GERD in patients undergoing OAGB with and without anti-reflux sutures (groups A and B, respectively). These patients had follow-ups for one year after the surgery. GERD symptoms were assessed in all the patients using the GERD symptom questionnaire.


The mean age was 39.5 ± 9.8 years and 40.7 ± 10.2 years in groups A and B respectively. GERD symptoms remission occurred in 76.5% and 68.4% of patients in groups A and B, respectively. The incidence of de novo GERD symptoms was lower in group A, compared to group B (6.2% and 16.1% in groups A and B respectively), without any statistically significant difference (p=0.239).

The researchers added that applying an anti-reflux suture can decrease de novo GERD symptoms.


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Early Marginal Ulcer After Roux-en-Y Gastric Bypass: MBSAQIP Database Analysis of Trends and Predictive Factors

Researchers from the Mayo Clinic, FL, have reported that the number of 30-day marginal ulcers (MU) from 213,104 patients undergoing laparoscopic RYGB occurred in 638 patients (0.3%), using 2015–2021 data from the MBSAQIP database.

Writing in Obesity Surgery, they noted that the predictive factors for 30-day MU after RYGB were renal insufficiency, history of DVT, previous cardiac stent, African American race, chronic steroid use, COPD, therapeutic anticoagulation, anastomotic leak test, GERD and operative time >120 min.

Additionally, patients who had 30-day MU showed significantly higher rates of overall complications such as pulmonary, cardiac and renal complications, unplanned ICU admission, blood transfusions, venous thromboembolism and non-home discharge (p < 0.05). The MU group showed similar rates of 30-day mortality as those without this complication (0.2% vs 0.1%, p=0.587).

Patients with MU required endoscopic interventions, readmissions and reoperations at rates of 88%, 72%, and 9%, respectively.

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Glucagon-Like Peptide-1 Receptor Agonists in Post-bariatric Surgery Patients: A Systematic Review and Meta-analysis

The current data is encouraging regarding use of glucagon-like peptide-1 receptor agonists (GLP1RA) for weight loss post-bariatric surgery, however the deterioration of bone health and muscle mass remains a concern needing further evaluation, according to a systematic review and meta-analysis by researchers from India.


Reporting in Obesity Surgery, they analysed eight studies (557 individuals) and compared to placebo, patients receiving liraglutide had significantly greater weight loss after six-month therapy (p<0.001). Compared to liraglutide, semaglutide had significantly greater percent reduction in body weight after six-month (p<0.001) and 12-month (p=0.004).


In addition, semaglutide had significantly higher rates of achieving >15% (p=0.03; n=207) and >10%  (p= 0.01; n=207] weight loss. However, there was also a significant decrease in fat mass (p< 0.001), lean mass (p=0.001) and whole-body bone mineral density (p=0.03) with liraglutide.


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Impact of bariatric surgery on anthropometric, metabolic, and reproductive outcomes in polycystic ovary syndrome: a systematic review and meta-analysis

Meta-analysis by an international team of researchers has found that women with polycystic ovary syndrome (PCOS) experience similar improvements in anthropometric, hormonal, and metabolic outcomes after bariatric surgery compared to those without PCOS.


Writing in Obesity Reviews, the investigators examined ten studies involving 432 women with and 590 women without PCOS. Comparisons between bariatric surgery and pharmacologic or lifestyle treatments were only reported in one study each, and most reproductive outcomes were limited to a single study; therefore, meta-analyses could not be performed.


The researchers stressed that the existing research is limited and of low quality with high risk of bias, especially in comparison to existing PCOS treatments and with respect to reproductive outcomes including pregnancy, highlighting the need for additional studies to inform clinical recommendations.


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Cancer Incidence, Type, and Survival After Bariatric Surgery

Researchers from Wisconsin, reporting in SOARD, have found that bariatric surgery reduces the risk for developing cancer and offers survival advantage, compared with similar patients who do not undergo bariatric surgery.


They retrospectively compared the rates and types of new incident cancers in a bariatric surgery cohort (Bariatric group) with those of a non-surgical cohort (Comparison group). After matching, the Bariatric group had 1,593 patients and the Comparison group had 2,156. The Bariatric and Comparison groups had 82 and 222 new incident cancer cases, respectively (p<0.001). The 10-year incidence of any new cancer in the Bariatric group was 6.5%, compared with an incidence of 12.1% in the Comparison group (p<0.001).


The relative risk of cancer in the Bariatric group was lower than that of the Comparison group, with the greatest differences in endometrial (88.8%), kidney (77.4%), thyroid (72.9%) and ductal carcinoma in situ (71.2%) cancers. The ten-year overall survival rate was higher in the Bariatric group than in the Comparison group, 93.3% versus 80.6%, respectively (p<0.001).


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Use of Preoperative Endoscopic Capsule-Based pH Testing Before Bariatric Surgery

Researchers from the University of South Carolina School of Medicine Greenville, Greenville, SC, writing in the Journal of the American College of Surgeons, report pre-surgical capsule-based pH testing could identify GERD and aid procedure selection.


The study authors compared capsule-based pH testing vs GERD symptom scoring to determine extent of preoperative GERD to aid in procedure selection for bariatric surgery. In total, 62 patients underwent preoperative endoscopy with capsule-based pH testing and completed GERD symptom assessment survey(s). Median BMI was 43.4 kg/m2 and 66.1% of patients were not taking a proton-pump inhibitor before performance of pH testing. There was negligible linear association between the objective DeMeester score obtained by capsule-based pH probe and GERD symptom survey scores. Median GERD symptom survey scores did not differ between patients with and without a diagnosis of GERD based on pH testing (all p>0.11).


“Capsule-based pH testing may prove to be superior to subjective symptom scoring systems in this patient population,” the researchers concluded.


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Effect of deep neuromuscular block on the quality of early recovery after sleeve gastrectomy in obese patients: a randomized controlled trial

Patients receiving deep neuromuscular block (NMB) during laparoscopic sleeve gastrectomy (LSG), had improved QoR-15 scores, greater diaphragmatic excursions, improved surgical conditions and lower visceral pain scores, researchers from the Affiliated Hospital of North Sichuan Medical College, Sichuan, China, have reported.


Writing in BMC Anesthesiology, 80 patients were randomised to receive either deep (post-tetanic count 1–3) or moderate (train-of-four count 1–3) NMB.  The quality of recovery was significantly better 24 h after surgery in patients who received a deep versus moderate block (114.4 ± 12.9 versus 102.1 ± 18.1). Diaphragm excursion was significantly greater in the deep NMB group when patients performed maximal inspiration at T2 and T3 (p<0.05).


Patients who underwent deep NMB reported lower visceral pain scores 40 min after surgery; additionally, these patients experienced lower pain during movement at T3 (p<0.05). Optimal surgical conditions were rated in 87.5% and 64.6% of all measurements during deep and moderate NMB respectively (p<0.001). The time to tracheal tube removal was significantly longer in the deep NMB group (p=0.001). There were no differences in other outcomes.


The researchers added that more evidence is needed to determine the effects of deep NMB on these outcomes.


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