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Journal Watch 22/02/2023

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 post-surgical suicide risk, effects of semaglutide on albuminuria and kidney function, early initiation of anti-obesity medications on weight loss, adverse events from the over-the-scope Endoscopic Suturing System (ESS) and routine preoperative EGD assessment in LAGB patients (please note, log-in maybe required to access the full paper).

Bariatric Surgery and Suicide Risk in Patients with Obesity

Bariatric surgery appears to be associated with a greater risk of suicidal ideation and attempts than non-surgical treatment of patients with severe obesity, according to researchers from Duke University, Durham, NC.

Writing in the Annals of Surgery, they examined the five-year suicidal ideation and attempt rates of veterans who underwent Roux-en-Y gastric bypass (RYGB) or laparoscopic sleeve gastrectomy (LSG) with matched non-surgical controls.

In the matched cohorts for suicidal ideation analyses, the majority were males (78.7%) and white (77.7%). Over 40% were treated for depression (41.8%), had a non-recent depression diagnosis (40.9%) and 4.1% had past suicidal ideation or suicide attempts more than one year prior to index.

Regression results found that risk of suicidal ideation was significantly higher for surgical patients (adjusted hazard ratio (aHR)=1.21, 95% confidence interval (CI): 1.03-1.41), as was risk of suicide attempt (aHR=1.62, 95% CI: 1.22-2.15).

The authors concluded that patients need careful monitoring for suicidal ideation and additional psychological support after bariatric surgery.

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Effects of Semaglutide on Albuminuria and Kidney Function in People With Overweight or Obesity With or Without Type 2 Diabetes: Exploratory Analysis From the STEP 1, 2, and 3 Trials

An international team of researchers has reported that semaglutide improved urine albumin-to-creatinine ratio (UACR) in adults with overweight/obesity and type 2 diabetes.

Writing in Diabetes Care, they conducted a post hoc analyses of the Semaglutide Treatment Effect in People with obesity (STEP) 1–3 trials and explored the effects of semaglutide (up to 2.4 mg) on kidney function. STEP 1–3 included adults with overweight/obesity; STEP 2 patients also had type 2 diabetes. Participants received once-weekly subcutaneous semaglutide 1.0 mg (STEP 2 only), 2.4 mg, or placebo for 68 weeks, plus lifestyle intervention (STEP 1 and 2) or intensive behavioral therapy (STEP 3). Changes in urine albumin-to-creatinine ratio (UACR) and UACR status from baseline to week 68 were assessed for STEP 2. Changes in estimated glomerular filtration rate (eGFR) were assessed from pooled STEP 1–3 data.

In STEP 2, 1,205 (99.6% total cohort) patients had UACR data; geometric mean baseline UACR was 13.7, 12.5, and 13.2 mg/g with semaglutide 1.0mg, 2.4mg, and placebo, respectively. At week 68, UACR changes were −14.8% and −20.6% with semaglutide 1.0 mg and 2.4 mg, respectively, and +18.3% with placebo (between-group differences [95% CI] vs. placebo: −28.0% [−37.3, −17.3], p<0.0001 for semaglutide 1.0mg; −32.9% [−41.6, −23.0], p=0.003 for semaglutide 2.4mg).

UACR status improved in greater proportions of patients with semaglutide 1.0mg and 2.4mg versus placebo (p=0.0004 and p=0.0014, respectively). In the pooled STEP 1–3 analyses, 3,379 participants had eGFR data; there was no difference between semaglutide 2.4 mg and placebo in eGFR trajectories at week 68.

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Preoperative and Early Adjuvant Weight Loss Medications in Bariatric Surgery Patients with BMI over 60 or Suboptimal Initial Response to Surgery

Investigators from the West Virginia University have concluded that for patients having bariatric surgery - who fall below the expected MBSAQIP weight loss curve - early initiation of anti-obesity medications can improve the weight loss, with preoperative pharmacotherapy having the greatest effect.

Writing in SOARD, they evaluated the impact of adjuvant pharmacotherapy on bariatric surgery outcomes. In their analysis, patients received pharmacotherapy either preoperatively if their BMI was >60, or in the first or second postoperative years for suboptimal weight loss.

In total, 98 patients were included in the study, with 93 (94.9%) undergoing sleeve gastrectomy and 5 (5.1%) undergoing RYGB surgery. During the study period patients were prescribed either phentermine and/or topiramate. At postoperative year one, patients who received pharmacotherapy preoperatively lost 31.3% of their total body weight (TBW) compared to 25.3% TBW for patients with suboptimal weight loss who received medication in the first postoperative year, and 20.8% TBW for patients who did not receive any anti-obesity medication in the first postoperative year.

Patients receiving medication preoperatively weighed 2.4% less than expected, whereas patients receiving medication during the first postoperative year weighed 4.8% higher than expected.

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Analysis of Reported Adverse Events Associated with Over-the-Scope Endoscopic Suturing System: an FDA MAUDE Database Study

Investigators from the University of Minnesota, Minneapolis, MN, have reported that the overall adverse events from the over-the-scope Endoscopic Suturing System (ESS) remain acceptable as evidenced by the number of reported cases since 2008.

The over-the-scope ESS (OverStitch) is one of the most widely utilised systems in current clinical practice; however, data on the adverse events associated with this device is scarce. Their study sought to evaluate the adverse events and complications associated with the over-the-scope ESS using the FDA’s Manufacturer and User Facility Device Experience (MAUDE) database, from January 2008 through June 2022.

Eighty-three reports were filed from January 2008 to June 2022 and the most common device-related issue was difficulty to remove after deployment (n=12, 15.58%) followed by mechanical problem (n=10, 12.99%), mechanical jam (n=9, 11.69%), or entrapment of device (n=9, 11.69%). Of the 87 patient-related adverse events, the most common was perforation (n=19; 21.84%), device embedded in tissue or plaque (n=10; 11.49%) and abdominal pain (n=8; 9.20%).

“It is important to note that adverse event rates might increase as the use of the device increases; therefore, it is essential for endoscopists to be aware of the potential common and rare adverse events associated with the use of the over-the-scope ESS device,” the authors concluded in Obesity Surgery.

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The yield of preoperative esophagogastroduodenoscopy in patients undergoing bariatric surgery after gastric banding

Researchers from the Netherlands have reported that routine preoperative assessment by esophagogastroduodenoscopy (EGD) in patients before bariatric surgery with an adjustable gastric band in situ still detects some severe abnormalities.

Reporting in Techniques and Innovations in Gastrointestinal Endoscopy (TIGE), the authors noted that EGD is routinely performed in patients who undergo conversion from adjustable gastric banding to another bariatric procedure of band removal.

In total, 514 patients (62 male, 452 female, mean age 46 years, mean BMI 40) underwent surgery with an adjustable gastric band in situ. In total 488 patients (95%) underwent preoperative EGD. No abnormalities were found in 205 patients (42%), 112 patients (23%) had abnormalities without treatment consequences, 156 patients (32%) had findings that required pharmaceutical (i.e. PPI and/or antibiotics) intervention and 15 patients (3.1%) had severe findings altering their management.

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