Journal Watch 20/8/2025

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 MBS and acute pancreatitis, CT reporting tool for the detection of IH after RYGB, formal training in bariatric endoscopy, balloon dilation vs. self-expandable metal stents for benign gastric outlet obstruction, Cagrilintide and Semaglutide outcomes and more (please note, log-in maybe required to access the full paper).

Impact of Metabolic Surgery on the Severity and Outcomes of Acute Pancreatitis: A Retrospective Matched Cohort Study

Metabolic and bariatric surgery (MBS), including Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion with duodenal switch (BPD/DS), does not worsen acute pancreatitis (AP) severity or outcomes and may improve them, possibly through weight loss and reduced comorbid conditions, according to researchers from the Mayo Clinic, Rochester, MA.

Writing in Obesity Surgery, they evaluated whether a history of MBS, particularly RYGB and BPD/DS, affects the severity and clinical outcomes of AP. This retrospective matched cohort study included patients admitted with AP to Mayo Clinic between 2013 and 2022. Patients with a history of RYGB or BPD/DS were matched to two control groups without prior bariatric surgery: (1) BMI-matched controls (± 1 kg/m2), and (2) higher-BMI controls (≥ 5 kg/m2 higher). The primary outcome was AP severity, and secondary outcomes included local complications, hospital length of stay, recurrence, and 30-day readmission.

Compared to the higher-BMI control group, the MBS group had lower rates of severe AP (0% vs. 26.3%, p<0.001), fewer local complications (10.5% vs. 57.9%, p<0.001), shorter hospital stays (median 3 vs. 10 days, p=0.044), and fewer AP recurrences at six months (21.1% vs. 50%, p=0.045). No significant differences were found between the MBS and BMI-matched groups.

The researchers added that further studies are needed to confirm these findings in larger, diverse populations.

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Implementation of a structured CT reporting tool for the detection of internal hernia after Roux-en-Y gastric bypass

Northwestern University Feinberg School of Medicine, Chicago, IL, have report that a structured tool for the detection of internal hernias with CT scans may improve the diagnosis rates of internal hernia among those who have undergone RYGB.

Reporting in Surgical Endoscopy, the researchers sought to improve the detection of internal hernias through the implementation of a structured CT reporting tool.

During the pre-intervention period, 139 CT scans were obtained. Five (3.0%) radiographic diagnoses of internal hernia were made, four of which underwent operative reduction. Six internal hernias (3.7%) were missed by CT. All six required surgical reduction, with one experiencing entire small bowel necrosis resulting in resection and small bowel transplantation.

During the post-intervention period, 49.7% of the 193 CT scans included the structured CT reporting tool. Eight (3.7%) radiographic diagnoses of internal hernia were made, six of which underwent operative reduction. Two diagnoses of internal hernia were missed on CT scan (1.1%). The sensitivity for internal hernia detection in the pre- and post-intervention groups was 40.0 vs. 75.0% (p=0.14), and the specificity was 99.2 vs. 98.9%, respectively (p=0.79).

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Formal Training in Bariatric Endoscopy: Assessing Interest and Need Among United States Gastroenterology Trainees

Researchers from Medical College of Georgia at Augusta University, GA, have reported that current gastroenterology (GI) trainees consider obesity an important disease and are interested in learning about bariatric endoscopy (BaE) during training, however a majority feel their current education is inadequate and are uncomfortable discussing BaE with patients.

Writing in Foregut, the Journal of the American Foregut Society, the carried out a survey among current GI trainees to evaluate their existing BaE education, gauge their interest in formal BaE training and determine the perceived necessity for specialised BaE education.

A total of 122 respondents completed the survey. General GI fellows were 93% and advanced endoscopy trainees were 7% of respondents. Obesity was seen as a significant issue by 91% of trainees and 80% felt BaE should be included in their didactic education. Only 7% felt they were adequately trained in BaE.

The researchers said their findings demonstrate a need for structured didactics and rotations for trainees regarding endoscopic obesity management.

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A real-world study of balloon dilation vs. self-expandable metal stents for benign gastric outlet obstruction

Chinese researchers have found that balloon dilation and self-expanding metal stents (SEMS) appear safe and effective for benign gastric outlet obstruction (GOO). However, SEMS are associated with higher cost and more complications, are not recommended as first choice for the management of benign GOO compared to balloon dilation.

Writing in BMC Gastroenterology, they examined the safety and efficacy of these two methods in benign GOO between September 2019 and March 2025. Patients were admitted for benign GOO and entered into the study, with balloon dilation or SEMS placement to dilate strictures. The two treatments were compared in terms of length of hospital stay, treatment costs, techniques and clinical outcomes, complications, as well as the GOO scoring system (GOOSS).

The technical success rates range from 76.5 to 87.1%. A significant increase in GOOSS was observed after procedure in all three groups, from GOOSS 1 to GOOSS 3 (p<0.05). Group A had the lowest incidence of complications (8.8%), while group B had the highest (38.7%, p=0.0141), including 6 (19.4%) stent restenosis, 3 (9.7%) migration, and 2 (6.5%) stent fracture or obstruction. A total of 32 patients (48.5%) were clinically cured, with the highest clinical cure rate of 68.2% in the group A (p=0.0389).

Compared with group A, more hospitalization costs were observed in the group B and C (p=0.0010). The number of treatment sessions, rate of stricture recurrence after first treatment, and duration of treatment were not statistically significant different in all three groups.

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Coadministered Cagrilintide and Semaglutide in Adults with Overweight or Obesity

An international team of researchers, reporting outcomes from the REDEFINE 1 study, have found Cagrilintide–semaglutide provided significant and clinically relevant body-weight reductions in adults with overweight or obesity, as compared with placebo.

Published in the New England Journal of Medicine, the phase 3a, 68-week, multicenter, double-blind, placebo-controlled and active-controlled trial, enrolled adults without diabetes who had a body-mass index 30 or higher or a BMI of 27 or higher with at least one obesity-related complication.

A total of 3,417 participants underwent randomization, with 2,108 assigned to receive cagrilintide–semaglutide, 302 to receive semaglutide, 302 to receive cagrilintide, and 705 to receive placebo. The estimated mean percent change in body weight from baseline to week 68 was –20.4% with cagrilintide–semaglutide as compared with –3.0% with placebo (estimated difference, –17.3 percentage points; 95% confidence interval, –18.1 to –16.6; p<0.001). Participants receiving cagrilintide–semaglutide were more likely than those receiving placebo to reach weight-loss targets of 5% or more, 20% or more, 25% or more, and 30% or more (P<0.001 for all comparisons).

Gastrointestinal adverse events (affecting 79.6% in the cagrilintide–semaglutide group and 39.9% in the placebo group), including nausea, vomiting, diarrhoea, constipation, or abdominal pain, were mainly transient and mild-to-moderate in severity.

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