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Journal Watch 23/08/2023

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 a paper reporting the long-term cancer outcomes after bariatric surgery, nurse-led case-managing interventions showed positive results, classifying slippage as a possible complication after laparoscopic BariClip gastroplasty and bariatric surgery may lead to negative outcomes in some cognitive domains, and more (please note, log-in maybe required to access the full paper).

Long-term cancer outcomes after bariatric surgery

Researcher from the University of Utah, Salt Lake City, UT, have reported that bariatric surgery was associated with lower all-cancer and obesity-related cancer incidence among female patients and cancer mortality was significantly lower among females in the surgical group versus the nonsurgical group.


Writing in the journal Obesity, the matched 21,837 bariatric surgery patients (1:1 by age, sex, and BMI) with a nonsurgical comparison group. Procedures included gastric bypass, gastric banding, sleeve gastrectomy, and duodenal switch. The primary outcomes included cancer incidence and mortality, stratified by obesity- and non-obesity-related cancers, sex, cancer stage, and procedure.


They found that bariatric surgery patients had a 25% lower risk of developing any cancers compared with a nonsurgical comparison group (p<0.001). Cancer incidence was lower among female (p<0.001) but not male surgery patients, with the HR lower for females than for males (p<0.001). Female surgery patients had a 41% lower risk for obesity-related cancers (i.e., breast, ovarian, uterine, and colon) compared with nonsurgical females (p<0.001). In addition, cancer mortality was significantly lower after surgery in females (p<0.001).


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Nurse-led intervention for the management of bariatric surgery patients: A systematic review

Investigators from the Universidade Lusófona's Research Center for Biosciences and Health Technologies (CBIOS), Lisbon, Portugal, have found that nurse-led case-management interventions, with a focus on behavioural change and multidisciplinary approaches, show promise in improving outcomes in bariatric surgery patients.


Reporting in Obesity Reviews, the systematic review sought to identify the most successful structural characteristics of case-managing interventions, with or without the support of e-Health, in the process of perioperative management of bariatric surgery patients.


They reported that nurse-led case-managing interventions with a multidisciplinary approach showed positive results in weight loss, physical activity, and quality of life. In addition, patient-centred care models were found to promote adherence to treatment and patient satisfaction. E-Health technologies improved quality of life but not weight loss.


They concluded that patient-centred care models and longer term interventions may contribute to sustained weight loss and better postoperative outcomes however, further research is needed to determine the optimal duration of interventions and the long-term effects on weight maintenance.


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Classification of Slippage Following Laparoscopic BariClip Gastroplasty

Slippage is a possible complication after laparoscopic BariClip gastroplasty (LBCG) and classifying the different types of slippage could benefit the surgeon in the management and treatment of this complication.


An international team of researchers, writing in Obesity Surgery, analysed different cases of slippage and proposed a classification of this complication. In total, 381 patients who underwent LBCG in eight different centres were analysed concerning the risk of slippage.


They identified a total of 17 cases (4.46%) of slippage following LBCG. In 11 patients, the slippage was symptomatic with repetitive vomiting and nausea, in the remaining six patients the slippage was identified by radiological studies for insufficient weight loss, weight regain or routine radiological follow-up. The slippage was classified (depending on the interval time) as either immediate (in first 7 days) in 6 cases, early (in less than 90 days) in 4 cases, and late (after 3 months) in 7 cases.


Evaluation of the radiological studies in these cases identified the following: anterosuperior displacement (type A) in 9 cases, posteroinferior displacement (type B) in 6 cases (one case after 3 months), and lateral displacement (type C) in the remaining 2 cases.


The treatment of the slippage consisted of BariClip removal in 7 cases, repositioning in 5 cases and conservative treatment in the remaining 5 cases.


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Presurgical microstructural coherence predicts cognitive change for bariatric surgery patients

Presurgical microstructural coherence is associated with magnitude of cognitive change after weight loss, according to researchers from the University of Florida, Gainesville, FL.


Reporting in the journal Obesity, they examined the relationship between presurgical white matter microstructural coherence and cognitive change after weight loss. They hypothesised that higher baseline fractional anisotropy (FA) would predict greater baseline and change cognition.


Twenty-four adults (BMI≥35kg/m2) underwent neuropsychological assessment at baseline and 12 weeks after bariatric surgery. An MRI brain scan was carried out at baseline and processed through Tract-Based Spatial Statistics to compute FA in white matter tracts of interest. They then calculated the composite scores for attention, learning, processing speed, executive function, verbal fluency, working memory and overall cognition.


FA in some tracts of interest was significantly (p<0.05) positively associated with change in cognition. Inverse relationships were observed between baseline FA and presurgical cognition, which they said may be explained by increased medial and radial diffusivity and preserved axonal diffusivity. Generally, cognition improved after surgery however, clinically nonsignificant deterioration was observed on learning measures, and poorer baseline cognitive performance was associated with greater postsurgical cognitive improvement.


“An observed reduction in learning suggests that bariatric surgery may lead to negative outcomes in some cognitive domains, at least temporarily,” they concluded.


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