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Journal Watch 25/01/2023

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 comparison of the early postoperative outcomes of primary and C/R laparoscopic SG to DS and GB; and primary procedures of each vs C/R counterparts, the outcomes of bariatric surgery between patients with and without ESRD and assessed the different methods of bariatric surgery in patients with ESRD, outcomes of patients with depression undergoing RYGB and SG, outcomes from the STEP 5 trial and a study assessing SADI-S and OAGB outcomes (please note, log-in maybe required to access the full paper).

Comparison of early post-operative complications in primary and revisional laparoscopic sleeve gastrectomy, gastric bypass, and duodenal switch MBSAQIP-reported cases from 2015 to 2019

Researchers from the University of North Carolina School of Medicine, Chapel Hill, NC, have reported that early complication rates are comparable between gastric bypass (GB) and duodenal switch (DS), and greater than sleeve gastrectomy (SG), especially as conversion/revision (C/R) procedures.

Writing in Surgical Endoscopy, their analysis compared early postoperative outcomes of primary and C/R laparoscopic SG to DS and GB; and primary procedures of each vs C/R counterparts.

Using data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) they looked at surgical site infection (SSI), reoperation, and readmission at 30 days in two initial comparisons: (1) primary SG vs DS or GB and (2) C/R SG vs DS or GB. A secondary analysis compared primary GS, GB, or DS with C/R counterparts. Models were adjusted for confounding demographics and comorbidities.

Of 755,968 primary cases, most were SG (72.8%), followed by GB (26.3%), then DS (0.9%). Compared to SG, GB and DS demonstrated higher odds of SSI (aOR 3.02 [2.84, 3.2]), readmission (aOR 1.97 [1.92, 2.03]) and reoperation (aOR 2.74 [2.62, 2.86]), respectively. Of 68,716 C/R cases, SG was most common (43.2%), followed by GB (37.5%), then DS (19.2%). C/R GB and DS demonstrated greater risk of SSI (aOR 2.28 [1.98, 2.62]), readmission (aOR 2.10 [1.94, 2.27]), and reoperation (aOR 2.3 [2.04, 2.59]) vs SG, respectively.

C/R SG and DS demonstrated greater risk of SSI (OR 2.09 [1.66, 2.63]; 1.63 [1.24, 2.14), readmission (OR 1.13 [1.02, 1.26]) and reoperation (OR 1.27 [1.06, 1.52]; 1.58 [1.24, 2.0]), vs primary procedures. C/R DS demonstrated greater risk of SSI (OR 1.23 [1.66, 2.63]).

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Bariatric Surgery in Patients with Obesity and End-Stage Renal Disease

Researchers from Germany have reported that bariatric surgery in patients with end-stage renal disease (ESRD) seem to have higher rates of major complications and perioperative mortality than in patients without ESRD, but a comparable rate of overall complications.

Writing in SOARD, they compared the outcomes of bariatric surgery between patients with and without ESRD and to assess different methods of bariatric surgery in patients with ESRD. Two meta-analyses were performed: A) to compare bariatric surgery outcomes among patients with and without ESRD, and B) to compare outcomes of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in patients with ESRD.

Of 5,895 articles, six studies were included in meta-analysis A and eight studies in meta-analysis B. Major postoperative complications (OR=2.82; 95% CI=1.66–4.77; p=0.0001), reoperation (OR=2.66; 95% CI=1.99–3.56; p<0.00001), readmission (OR=2.37; 95% CI=1.55–3.64; p<0.0001), and in-hospital/90-day mortality (OR=4.03; 95% CI=1.80–9.03; p=0.0007) were higher in patients with ESRD. Patients with ESRD also had a longer hospital stay (MD=1.23; 95% CI=0.32–2.14; p=0.008). Bleeding, leakage, and total weight loss were comparable among groups. SG showed a 10% lower rate of overall complications and significantly shorter hospital stay than RYGB did. The quality of evidence was very low for the outcomes.

They concluded that SG has fewer postoperative complications and could be the method of choice in these patients. These findings should be interpreted cautiously in light of the moderate to high risk of bias in most included studies.

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Preoperative Depression Status and Five Year Metabolic and Bariatric Surgery Outcomes in the PCORnet Bariatric Study Cohort

US researchers have found that patients with depression undergoing RYGB and SG had similar weight loss, diabetes and safety/utilisation outcomes to those without depression, and the effects of depression were clinically small compared to the choice of operation.

Writing in the Annals of Surgery, they examined whether depression status before metabolic and bariatric surgery (MBS) influenced five-year weight loss, diabetes and safety/utilization outcomes in the PCORnet Bariatric Study.

They used data from 23 health systems on 36,871 patients who underwent sleeve gastrectomy (SG; n=16,158) or gastric bypass (RYGB; n=20,713) from 2005–2015. Patients with and without a depression diagnosis in the year prior to MBS were evaluated for % total weight loss (%TWL), diabetes outcomes and postsurgical safety/utilisation (reoperations, revisions, endoscopy, hospitalizations, mortality) at one, three and five years after MBS.

They reported that 27.1% of SG and 33.0% of RYGB patients had preoperative depression, and they had more medical and psychiatric comorbidities than those without depression. At five years of follow-up, those with depression, versus those without depression, had slightly less %TWL after RYGB, but not after SG (between group difference = 0.42%TWL, p=0.04). However, patients with depression had slightly larger HbA1c improvements after RYGB but not after SG (between group difference = -0.19, p=0.04). Baseline depression did not moderate diabetes remission or relapse, reoperations, revision, or mortality across operations; however, baseline depression did moderate the risk of endoscopy and repeat hospitalization across RYGB versus SG.

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Two-year effect of semaglutide 2.4 mg on control of eating in adults with overweight/obesity: STEP 5

An international team of researchers, writing in Obesity, have report that adults with overweight/obesity, semaglutide 2.4 mg improved short- and longer-term control of eating associated with substantial weight loss.

In STEP 5, adults with overweight/obesity were randomized 1:1 to semaglutide 2.4 mg or placebo, plus lifestyle modification, for 104 weeks. A 19-item Control of Eating Questionnaire was administered at weeks 0, 20, 52, and 104 in a subgroup of participants.

In participants completing the Control of Eating Questionnaire (semaglutide, n=88; placebo, n=86), mean body weight changes were −14.8% (semaglutide) and −2.4% (placebo). Scores significantly improved with semaglutide versus placebo for Craving Control and Craving for Savory domains at weeks 20, 52, and 104 (p<0.01); for Positive Mood and Craving for Sweet domains at weeks 20 and 52 (p<0.05); and for hunger and fullness at week 20 (p<0.001). Improvements in craving domain scores were positively correlated with reductions in body weight from baseline to week 104 with semaglutide.

At 104 weeks, scores for desire to eat salty and spicy food, cravings for dairy and starchy foods, difficulty in resisting cravings, and control of eating were significantly reduced with semaglutide versus placebo (all p<0.05).

To read our summary, please click here

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One Anastomosis Gastric Bypass Versus Single Anastomosis Duodenoileostomy with Sleeve: Comparative Analysis of 30-Day Outcomes Using the MBSAQIP

US researchers have reported single anastomosis duodenoileostomy with sleeve (SADI-S) patients had higher readmission rates and higher Clavien-Dindo grade 2 and 4b complications, compared to one anastomosis gastric bypass (OAGB) patients.

Reporting in Obesity Surgery they compared the outcomes and safety profiles of SADI-S and OAGB using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database.

A total of 694 and 1,068 patients respectively underwent SADI-S or OAGB. Statistically significant comorbidities included age (42.2 ± 10.8 vs. 43.7 ± 12.2), BMI (50.6 ± 9.1 vs. 45.3 ± 7.1), ASA 2 (66 (9.5%) vs. 165 (15.4%)), ASA 4 [69 (9.9%) vs. 20 (1.9%)], and immunosuppressive therapy [24 (3.5%) vs. 17 (1.6%)]. Clavien-Dindo-based analysis highlighted that SADI-S had higher grade 2 (p = 0.005) and grade 4b (p=0.001) complications. Patients who underwent SADI-S were twice as likely to be readmitted within 30 days (3.7% vs. 1.9%; p=0.021).

The researchers added that further studies are needed to determine the long-term complications and efficacy of both operations.

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