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 outcomes after three redo bariatric procedures, adolescences RYGB patients and management strategies to reduce energy intake, Medicaid expansion was associated with significant improvements in health care access among adults with obesity, the utility of intraoperative endoscopy to detect gastric stenosis during LSG and the significant geographic variation in the use of sleeve gastrectomy following the initiation of insurance coverage (please note, log-in maybe required to access the full paper).
Challenges in Bariatric Surgery: Outcomes in Patients Having Three or More Bariatric Procedures
Italian and French researchers, reporting in Obesity Surgery, have reported that redo bariatric surgery either conversional or revisional is feasible and effective in patients with a complex bariatric history including two or more previous procedures.
In their study, they investigators evaluated the feasibility and outcomes of revisional surgery in patients with at least two or more previous bariatric procedures. The study included 30 patients who underwent a third bariatric procedure.
The complication rate was 33%; no patient required additional surgery because of postoperative complications. A total weight loss of 29.6% and an excess loss of 53.4% were obtained at a mean follow-up of 61 months after the last redo bariatric procedure.
The authors concluded that careful patients’ selection is mandatory and extensive information should be given on the increased risk of postoperative complications.
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Long-term changes in dietary intake and its association to eating-related problems after gastric bypass in adolescents
Swedish investigators, reporting in SOARD, have reported on the importance of giving adolescences undergoing roux-en-Y gastric bypass (RYGB) surgery management strategies to reduce energy intake.
They noted that the long-term dietary intake and the relationship to eating-related problems are scarcely evaluated in this population. Therefore, they assessed changes in dietary intake in adolescents after RYGB and explored the associations between dietary intake and eating-related problems.
After five years RYGB adolescents reported reduced: energy intake, portion size of cooked meals at dinner and milk/yoghurt (p<0.01). Binge Eating Scale (BES) -score was 9.3±8.3 vs. 13.4±10.5, RYGB vs. controls (p=0.04). Association between BES-score and energy intake was stronger in controls (p<0.001). At five years lower energy intake was associated with greater BMI loss in all adolescents: (p<0.001). Higher scores in BES, uncontrolled, and emotional eating were associated with higher energy intake, cooked meals, candies/chocolates, cakes/cookies, desserts, and sugary drinks (p<0.04), and lower intake of fruits/berries (p=0.044).
The authors stated that to support optimisation of long-term outcome of adolescent RYGB it is important to give management strategies to reduce energy intake.
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Medicaid expansion and health care access for individuals with obesity in the United States
Researchers from the United States have found that Medicaid expansion was associated with significant improvements in health care access among adults with obesity, but these improvements were variable across race and ethnicity.
Reporting in the journal Obesity, the study aimed to evaluate associations of Medicaid expansion with health care access for adults with obesity and to explore racial/ethnic differences in these changes in health care access.
They reported that Medicaid expansion was associated with improvements in health care access, including lower proportions of those without a usual source of care and cost as a barrier to medical care. Medicaid expansion was consistently associated with better access among non-Hispanic White adults p<0.01) and not at all among non-Hispanic Black and Hispanic adults (p>0.05).
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The utility of intraoperative endoscopy to assist novice surgeons in the detection of gastric stenosis during laparoscopic sleeve gastrectomy
Investigators from Taiwan have concluded that intraoperative endoscopy (IOE) can help detect gastric stenosis during laparoscopic sleeve gastrectomy (LSG), especially for novice surgeons and the stenosis can be resolved during operation.
Writing in BMC Surgery, from 352 patients three (0.9%) were found to have stenosis by IOE, which was related to tightly gastropexy stitch or reinforcement stitch. Stenosis was resolved after removal of the stitch during LSG.
They concluded that IOE can help detect gastric stenosis during LSG, especially for surgeons less experienced in LSG however, because no leak was detected by IOE or occurred after LSG in the present study, the use of IOE with a leak test to prevent leaks is not necessary.
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Association of Insurance Coverage With Adoption of Sleeve Gastrectomy vs Gastric Bypass for Patients Undergoing Bariatric Surgery
US researchers have reported there was significant geographic variation in the use of sleeve gastrectomy following initiation of insurance coverage.
Writing in JAMA Network, they sought to evaluate regional variation in sleeve gastrectomy following insurance coverage implementation as an instrumental variable in comparative effectiveness research. Their serial cross-sectional study included adult patients in a national Medicare claims database who underwent LSG or RYGB from 2012 to 2017.
The researchers reported that after insurance coverage initiation, there was substantial regional and temporal variation in adoption of sleeve gastrectomy. Prior-year state-level utilisation of sleeve gastrectomy was highly associated with undergoing sleeve gastrectomy. All but two patient characteristics (race and diagnosis of depression) were well-balanced between the top and bottom quartiles of the instrumental variable. Regarding one-year outcomes, compared with patients undergoing gastric bypass, patients undergoing sleeve gastrectomy had a lower one-year risk of mortality, complications, emergency department visits, hospitalisation and reinterventions.
The researchers noted that this approach could be applied to other areas of health services research to serve as a complement to clinical trials.
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