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Journal Watch 24/1/2024

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 from OAGB-RYGB conversion, cognitive function after adolescent bariatric surgery, SleeveBypass results, ForePass endoscopic bypass device and MBS in Obesity Class V patients, and more (please note, log-in maybe required to access the full paper).

Outcomes of One-Anastomosis Gastric Bypass Conversion to Roux-en-Y Gastric Bypass for Severe Obesity: A Systematic Review and Meta-analysis

One-anastomosis gastric bypass to Roux-en-Y gastric bypass conversion leads to resolution of reflux symptoms, according to investigators from Imperial College London, London, UK.

Writing in Obesity Surgery, they conducted a systematic review to determine the safety and efficacy associated with OAGB-RYGB conversion. They identified six studies including 134 patients who had OAGB-RYGB conversion.

The most common indications for conversion were reflux (47.8%) malnutrition (31.3%) and inadequate weight loss (8.2%). Post-conversion, all the studies reported 100% resolution of bile reflux with a medium-term weight gain of 0.61 BMI.

The authors caution that RYGB is associated with weight regain, although this may be acceptable to patients to treat their biliary reflux.

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Cognitive function 10 years after adolescent bariatric surgery

The latest paper from the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) Consortium has found cognitive deficits are common ten years after bariatric surgery.

Reporting in SOARD, the study authors examine cognitive function 99 young adults who underwent bariatric surgery as adolescents 10 years following surgery. The subjects completed a computerised cognitive test battery as part of a larger ten-year post-operative assessment.

They found that cognitive dysfunction was prevalent on tests of attention and executive function and 53.5% of subjects met research criteria for mild cognitive impairment (MCI). Participants with pre-operative hypertension and those completing RYGB were more likely to meet criteria for MCI at ten-year follow-up.

The authors said that “additional studies are needed to clarify possible cohort effects, determine whether these cognitive deficits persist to even later follow-up (e.g., 20 years post-surgery), and identify underlying mechanisms and mitigation strategies.”

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Long-term effect of sleeve gastrectomy vs Roux-en-Y gastric bypass in people living with severe obesity: A phase III multicentre randomised controlled trial (SleeveBypass)

The latest outcomes from the SleeveBypass studies have reported Roux-en-Y gastric bypass showed significantly higher total weight loss and significant advantages in secondary outcomes, including dyslipidaemia and GERD, yet at a higher rate of minor complications, compared with sleeve.

Reporting The Lancet Regional Health Europe, Scandinavian researchers compared 628 patients (sleeve gastrectomy, n=312 and RYGB, n=316).

At five years, excess BMI loss was 58.8% after sleeve gastrectomy and 67.1% after Roux-en-Y gastric bypass (p<0.001), total weight loss was 22.5% after sleeve gastrectomy and 26.0% after Roux-en-Y gastric bypass with obesity-related comorbidities significantly improving in both groups.

Overall, both procedures had clinically comparable excess BMI loss according to the predefined definition for equivalence. Importantly, major complications, other comorbidities and overall HRQoL did not significantly differ between the groups.

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ForePass endoscopic bypass device for obesity and insulin resistance—metabolic treatment in a swine model

An international team of researcher, writing in Gut, has concluded that the ForePass endoscopic device results in a 79% reduction in weight gain compared to the control group in a swine model, suggesting it may be substantially more effective than common metabolic surgeries like gastric bypass.

The ForePass device links the stomach to the jejunum via a gastric funnel connected to an intestinal sleeve. The balloon, which reduces the gastric volume by approximately 2/3, is traversed by a central channel that connects to the sleeve, which extends through the duodenum and proximal jejunum. subsequently, ingested foods bypass the duodenum and proximal jejunum arriving directly into the mid-jejunum.

The study’s goals were to evaluate the ForePass device's impact on weight, insulin sensitivity and faecal microbiota in four pigs, compared to a control group that did not undergo the procedure. The researchers hypothesised that the ForePass, which limits food intake and bypasses the upper gut, significantly improves glucose disposal and reduces weight gain in pigs relative to controls.

They assessed glucose disposal, weight gain, metabolomics and faecal microbiota in eight pigs that were assigned to either Sham-operation (controls) or Forepass. After fourweeks, they reported a large reduction (79%) in the overall weight gain in part due to reduced food intake (22%) and in part to incomplete food digestion with increased faecal nutrient loss in the group with ForePass as compared with sham operation. There were no reported instances of macroscopical or microscopical lesions of the stomach and duodenal mucosa and submucosa.

In addition, they observed a significant decrease in plasma glucose, insulin and C-peptide levels in response to an intragastric glucose load in ForePass group, with insulin sensitivity significantly higher in the ForePass than in the sham group.

The study authors concluded that the ForePass device could be used for those hesitant in undergoing surgery, high-risk patients who are ineligible for surgery, as a bridge to surgery, as well as a complement or substitute to new anti-obesity and anti-diabetic medications for these lifelong diseases.

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Metabolic and Bariatric Surgery in Patients with Obesity Class V (BMI > 60 kg/m2): a Modified Delphi Study

SADI-S, RYGB and OAGB were the top three preferred operations for patients with Obesity Class V, according to the outcomes from a Modified Delphi Study by an international team of researchers, writing in Obesity Surgery.

A total of 36 highly experienced metabolic and bariatric surgeons participated in the consensus. More than 90% of the experts agreed that patients should be notified of the greater risk of complications, the possibility of modifications to the surgical procedure and the early start of chemical thromboprophylaxis. Interestingly, no consensus was reached on the limb length in SADI-S, RYGB and OAGB operations.

According to the authors, this is the first attempt to reach consensus on the choice of procedures and perioperative management in this group of patients, and they noted that more research is needed to better serve this high-risk population.

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