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Journal Watch 23/06/2022

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 ten-year outcomes from the SLEEVEPASS RCT, OAGB as a revisional procedure after ‘failed’ LSG, an outline of the TAILOR OAGB limb length study, sex and bariatric procedure type on the increased risk of cancer and the impact of age on quality of life after gastric bypass (please note, log-in maybe required to access the full paper).

Effect of Laparoscopic Sleeve Gastrectomy vs Roux-en-Y Gastric Bypass on Weight Loss, Comorbidities, and Reflux at 10 Years in Adult Patients With Obesity - The SLEEVEPASS Randomized Clinical Trial

Ten-year outcomes from the SLEEVEPASS Randomized Clinical Trial - a study comparing the long-term outcomes of weight loss and remission of obesity-related comorbidities after laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) - has reported %EWL was greater after LRYGB compared with LSG, and the procedures were not equivalent for weight loss at ten years.

Writing in JAMA NetWork, the ten-year observational study evaluated 240 patients in the Sleeve vs Bypass (SLEEVEPASS) multicentre equivalence randomised clinical trial comparing LSG and LRYGB in the treatment of severe obesity in which 240 patients aged 18 to 60 years with median body mass index of 44.6 were randomized to LSG (n=121) or LRYGB (n = 119). The initial trial was conducted from April 2008 to June 2010 in Finland, with last follow-up in January 2021. The primary end point was five-year %EWL), this latest paper analysis focused on ten-year outcomes with special reference to reflux and BE.

At ten years, the estimated mean %EWL was 43.5% after LSG and 51.9% after LRYGB. The model-based estimate of mean %EWL was 8.4 percentage points higher after LRYGB (based on predefined margins of equivalence (−9 to 9), the two groups were not equivalent for weight loss as the whole confidence interval was not within the predefined margins).

The prevalence of esophagitis was significantly higher after LSG than LRYGB; 31% (28 of 91) vs 7% (6 of 85), respectively (p<0.001). De novo BE was found in four of 91 patients (4%) after LSG and in three of 85 (4%) after LRYGB (p=0.29). Patients in the LSG group had significantly greater PPI intake (58 of 90 [64%] vs 30 of 84 [36%]; p<0.001), higher GERD-HRQL total score (10.5 vs 0.0; p<0.001), and more reflux symptoms vs patients in the LRYGB group at ten years. Patients with esophagitis after LSG had significantly more de novo GERD symptoms compared with the retrospective.

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Five-year outcomes of one anastomosis gastric bypass as conversional surgery following sleeve gastrectomy for weight loss failure

One anastomosis gastric bypass (OAGB) is an effective and safe conversional bariatric surgical procedure for insufficient weight loss and weight regain following sleeve gastrectomy (SG), according to researchers from the Iran University of Medical Sciences, Tehran, The findings were published in Scientific Reports.

Using data from the were collected from the Iranian National Obesity Surgery Database (INOSD) and all surgical procedures were performed at a tertiary, academic and accredited IFSO-EC bariatric surgery centre.

All the patients who had undergone OAGB from September 2014 to January 2017 were evaluated. In total, 1,356 patients had an OAGB, including 73 cases as conversion surgery with 29 patients having a conversional OAGB following SG due to weight regain or incomplete weight loss (SG ‘failure’ was defined as an unsatisfying weight loss (EWL<50% in one year), a BMI>35 kg/m2 after reaching the appropriate weight or 25% EWL increase from the nadir weight) with 23 patients completing five-year follow up.

The indication of conversion to OAGB was SG failure in all the cases, including 39% (n=9) for weight regain and 61% (n=14) for weight loss failure, and the mean age of the patients was 42.4 years and the majority (87.0%) were female.

The repeated measurement analysis showed statistically significant (p<0.001) changes in the trend of BMI, which had reached its nadir year two after he surgery. Mean BMI before conversional surgery, at one, two, three and five-year follow-ups were 46.3±10.4, 34.5±8.5, 34.1±8.6, 35.7±8.7 and 37.5±11.6, respectively. Mean %EWL at one, two, three and five-year follow-ups were 51.6±11.0, 52.9±13.1, 45.5±16.4 and 41.0±18.0, respectively. Mean %TWL at one, two, three and five-year follow-ups were 26.6±5.9, 27.4±7.2, 23.9±9.2 and 20.9±9.3, respectively.

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Tailoring limb length based on total small bowel length in one anastomosis gastric bypass surgery (TAILOR study): study protocol for a randomized controlled trial

Researchers from The Netherlands writing in BMC Trials have published the an outline of the TAILOR Study that is investigating whether tailoring the length of the BP-limb based on total small bowel length (TSBL) leads to better results in terms of weight loss, vitamin deficiencies and bowel movements compared to a fixed BP-limb length.

The TAILOR study is a double-blind single-centre randomised controlled trial. Patients scheduled for primary OAGB surgery will be randomly allocated either to a standard BP-limb of 150 cm or to a BP-limb length based on their TSBL: TSBL < 500 cm, BP-limb 150 cm; TSBL 500–700 cm, BP-limb 180 cm; TSBL > 700 cm, BP-limb 210 cm. The primary outcome is to compare the percent total weight loss (%TWL) at 5 years between the two groups. Secondary outcomes include nutritional deficiencies, remission of comorbidities, symptoms of dumping, quality of life, and daily bowel movements. The study includes a total of 212 patients and is designed to detect a 5% difference in the primary endpoint.

The TAILOR study will provide new insights into the effect of different BP-limb lengths and the role of the TSBL in the OAGB. The study is designed to provide guidance for bariatric surgeons to determine the optimal BP-limb length in the OAGB.

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Colorectal Cancer Risk Is Impacted by Sex and Type of Surgery After Bariatric Surgery

Researchers from Ohio State University, writing in Obesity Surgery, have reported that there is an increased risk of CRC in males compared to females after bariatric surgery. Compared to controls, there was a decrease in CRC risk in females’ post-RYGB but not VSG.

There retrospective cohort study used the 2012–2020 MarketScan database and included 327,734 controls with severe obesity and 88,630 patients with Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (VSG). In females, CRC risk decreased post-RYGB compared to controls (p=0.02).

However, VSG was not associated with lower CRC risk in females. However, in males compared to controls, CRC risk trended toward an almost significant increase, especially after three years or more from surgery (p=0.06).

They concluded that mechanistic studies are needed to explain these differences.

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Impact of age on Quality of Life after Gastric Bypass. Data from the Scandinavian Obesity Surgery Registry (SOReg)

Patients ≥60 years report pronounced and sustained improvements in physical and obesity-specific QoL five years postoperatively, according to researchers reporting the latest analysis from the Scandinavian Obesity Surgery Register (SOReg).

For the study, published in SOARD, the authors assessed the impact of age on health-related quality-of-life (QoL) over time after gastric bypass.

Data of 57,215 patients undergoing gastric bypass with a follow up rate at one-, two and five- years at 89%, 69% and 59% respectively. Patients were divided into five-years age intervals.

Preoperatively, patients ≥60 years scored mental aspects and obesity related problem (OP) scale better than the entire cohort of patients; whereas physical SF-36 was lower for all (p<0.001). In all age groups, mental aspects were improved at one and two years but decreased to baseline at five years. Conversely, the postoperative improvements in physical SF-36 and OP sustained in all age groups.

The concluded that mental QoL is transiently improved after bariatric surgery, without marked differences between age groups. However, patients ≥60 years report pronounced and sustained improvements in physical and obesity-specific QoL five years postoperatively.

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