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 MBS on psoriasis symptoms and severity, the feasibility of the Sutureless Neodymium Anastomosis Procedure, endoluminal vacuum therapy for Post-MBS leakage, risk of early bowel obstruction following MBS and Difficulty to control eating score at three months post-SG is an independent early predictor of optimal response, and more (please note, log-in maybe required to access the full paper).
The Long-Term Impact of Bariatric Surgery on Psoriasis Symptoms and Severity: A Prospective Observational Study
Metabolic and bariatric surgery (MBS) can reduce psoriasis severity and lower the number of needed treatments, according to researchers from Iran University of Medical Sciences, Tehran, Iran.
Writing in SOARD, they investigate changes to psoriasis symptoms, severity, and treatment agents in 32 patients (female n=29, mean age 46.6±10.8 years) with obesity and psoriasis who underwent MBS (e.g., Roux-en-Y gastric bypass, one anastomosis gastric bypass, sleeve gastrectomy) from January 2010 to December 2020, who were followed-up for 70.6±29.1 months.
The researchers reported a significant decrease in postoperative BMI from 41.5±4.7 to 30±5.5 kg/m2 (p<0.001). Psoriasis Area and Severity Index (PASI) score significantly decreased from a median (IQR) of 3.6 (5.90) to 1.20 (3.45) after MBS (p = 0.006). The number of patients who reported nail involvement significantly decreased following surgery (p=0.039), although no significant difference in joint involvement was noted (p=1.000).
The researchers concluded that given psoriasis's complexity and varied individual responses, a personalised treatment is essential and further research is necessary to validate these findings in a larger population.
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Duodeno-ileal diversion with self-forming magnets in a sutureless neodymium anastomosis procedure (SNAP) for weight recidivism after sleeve gastrectomy: feasibility and 9-month results
Using a Sutureless Neodymium Anastomosis Procedure (SNAP) is technically feasible and relatively safe, with all patients presenting widely patent anastomosis at three months and experienced a progressive, clinically meaningful weight loss, according to an international team of researchers.
Writing in Surgical Endoscopy, they sought to assess the technical feasibility and safety of a minimally invasive, duodeno-ileal side-to-side anastomosis using SNAP for patients with weight recurrence or inadequate weight loss following SG.
This is a prospective, single-arm, open-label pilot study that enrolled 27 patients (mean age: 50.6 ± 9.1, mean BMI: 38.1 ± 4.6 kg/m2) with obesity to assist in weight reduction following an SG performed > 12 months prior.
They report no device-related serious adverse events and upper endoscopy at three months confirmed patent, healthy anastomoses in all patients. At nine months, patients (n=24) experienced 11.9±6.2%, 14.5±10.8% and 17.0±13.9% TBWL at three, six and nine months, respectively.
The investigators concluded that additional studies are needed to confirm these findings.
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Endoluminal Vacuum Therapy as Effective Treatment for Patients with Postoperative Leakage After Metabolic Bariatric Surgery—A Single-Center Experience
Researchers from Medical University of Vienna, Vienna, Austria, have reported that endoluminal vacuum therapy (EVT) instead of revisional surgery prevents the need for further reoperation and reduces associated morbidity and mortality in critically ill patients.
Writing in Obesity Surgery, the study authors evaluated the efficacy of EVT and its potential as endoscopic alternative to revisional surgery in 21 patients. In 11 cases (52.4%), the index surgery was a primary bariatric intervention; in 10 cases (47.6%), a secondary surgery after initial MBS was performed.
The favoured approach was a combination of revisional surgery and EVT (n=18; 85.7%), intermediate self-expanding metal stent (SEMS) in 16 (76.2%) cases. EVT was changed six times (0–33) every 3–4 days. Mean EVT time was 25.1 days (3–97). No severe associated complications were detected and EVT showed an efficacy of 95.2%.
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Rare Events Model of the MBSAQIP Database: Risk of Early Bowel Obstruction Following Metabolic Surgery
In the largest analysis to date, Roux-en-Y gastric bypass (RYGB) accounts for the largest proportion of early small bowel obstruction (eSBO), however, duodenal switch (DS) has a higher risk adjusted rate of eSBO, according to researchers from Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA.
Reporting in SOARD, they used data from the MBSAQIP database and from 1,016,484 records the incidence of eSBO was 0.40%. Of the 4,103 occurrences of eSBO - RYGB, SG (sleeve gastrectomy), and DS accounted for 79.4%, 19.3%, and 1.3%, respectively.
They reported patient-specific characteristics were significantly associated with increased eSBO including a history of prior foregut surgery, a non-metabolic surgery trained operator and longer operative times (all p<0.0001). While simultaneously controlling for these factors, eSBO remained higher in DS (OR 9.55, p<0.0001) and RYGB (p=<0.0001) compared to SG. Increased length of operation (OR 1.03, p<0.0001) and non-MS-trained operators (p<0.0001) remained highly significant. Male-sex (p=<0.0001) and diabetes (p<0.0001) were both protective.
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Stronger control of eating 3 months after sleeve gastrectomy predicts successful weight loss outcomes at one year
Difficulty to control eating score at three months post-SG is an independent early predictor of optimal response (achieving a successful TWL target of ≥25 % at one-year post-SG), researchers from University of California San Diego, La Jolla, CA, have reported in Obesity Pillars.
The researchers assessed and quantify the association between eating control and weight loss outcomes and identify the control of eating (CoE) attributes during the early postoperative period that might predict good vs. poor response to SG at one year.
They included 41 participants (80.5% females, 51.2% Hispanic, mean age 41.7±10.6, median baseline body mass index (BMI) 43.6 kg/m2 [range 35.2–66.3]) who completed the CoEQ at all four timepoints. The “Difficulty to control eating” score at 3 months revealed the highest area under the curve (AUC) (AUC 0.711; 95%CI 0.524–0.898; p=0.032). Score ≤7 at three months was strongly independently associated with a successful weight loss target of 25%TWL at one-year post-SG (Relative Risk 4.43; 95%CI 1.06–18.54; p=0.042).
“Our results support the utility of this easy-to-administer validated tool for predicting the effectiveness of SG and may assist in identifying individuals with suboptimal response early and helping them with interventions to attain optimal weight loss targets,” the researchers concluded.
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