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Journal watch 25/09/2024

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 STAMPEDE Trial identifies novel metabolomic fingerprint, conversion from SG to Ring-augmented RYGB, MBS in adolescents with severe obesity, barriers hindering the provision of primary care following bariatric surgery and OAGB has reduced operational expenses but SADJB-SG offers a broader range of applicability, and more (please note, log-in maybe required to access the full paper).

Metabolomic Fingerprints of Medical Therapy Versus Bariatric Surgery in Patients With Obesity and Type 2 Diabetes: The STAMPEDE Trial

STAMPEDE Trial investigators have identified a novel metabolomic fingerprint characterising the longer-term adaptations to medical therapy (MT), Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), indicating equivalent weight loss may be achieved by divergent effects on metabolism, according to researchers from the Cleveland Clinic, Cleveland, OH and the Pennington Biomedical Research Center, Baton Rouge, LA.


Reporting in Diabetes Care, the research team took plasma samples from 90 patients (age 49.9±7.6 years; 57.7% female) randomly assigned to MT (n=30), RYGB (n=30) or SG (n=30) were retrospectively subjected to untargeted metabolomic analysis using ultra performance liquid chromatography with tandem mass spectrometry at baseline and 24 months of treatment.

The circulating metabolome was dramatically remodelled after SG and RYGB, with largely overlapping signatures after MT. Compared with MT, SG and RYGB profoundly enhanced the concentration of metabolites associated with lipid and amino acid signalling, while limiting xenobiotic metabolites, a function of decreased medication use.


Random forest analysis revealed 2-hydroxydecanoate as having selective importance to RYGB and as the most distinguishing feature between MT, SG, and RYGB. The change in 2-hydroxydecanoate correlated with reductions in fasting glucose after RYGB, but not after SG or MT.


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Short-term safety and effectiveness of conversion from sleeve gastrectomy to Ring augmented Roux-en-Y gastric bypass

Conversion from sleeve gastrectomy (SG) to Ring-augmented RYGB (RaRYGB, utilising the MiniMizer Ring, Bariatric Solutions)) is adequate and successful regarding additional weight loss one-year after conversion, cumulative weight loss, complication rate and achievement of improvement or remission of medical-associated problems, according to researchers from The Netherlands.


Reporting in BMC Surgery, 50 patients (n=44 female). Mean pre-conversion BMI was 37.6 kg/m2 and after one-year mean TWL was 17.8% while mean cumulative TWL, calculated from primary SG, was 32%. A total of ten complications occurred in eight patients within 30 days, six of which were ≤CD3a and 4 ≥CD3b. One MiniMizer Ring was removed for complaints of severe dysphagia.


Of the 35 medical-associated problems present at screening five remained unchanged (14.2%), 15 improved (42.9%) and 15 achieved remission (42.9%).


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Metabolic and bariatric surgery outcomes in adolescents: a single center’s seven-year update

Metabolic and bariatric surgery (MBS) is a safe and effective method of achieving weight loss and comorbidity resolution in adolescents with severe obesity, according to investigators from Massachusetts General Hospital, Boston, MA,


Writing in Surgical Endoscopy, they assessed outcomes including follow-up, weight loss, comorbidity resolution, and complications among recent adolescent and young adult MBS patients from 2014 and 2020. There were 79 patients of whom 73% were female; overall, 53% were White, 24% Hispanic, and 15% non-Hispanic Black. The majority (80%) of patients underwent LSG.


The median %TBWL of LSG patients was 23% at a median follow-up of 3 years and for  LRYGB patients was 28% at 2.4 years. No preoperative factors were associated with follow-up or final %TBWL, but 6-month %TBWL predicted final %TBWL.


Preoperatively, 73% of patients had at least one weight-related comorbidity and 57% had documented improvements in at least one after surgery. There were three 30-day readmissions and no mortalities.


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Primary care practitioner and patient perspectives on care following bariatric surgery: A meta-synthesis of qualitative research

Barriers hindering the provision of primary care following bariatric surgery include adverse surgical outcomes, a poor relationship with their primary care practitioner (PCP) and limited and short-term follow-up care from the PCP, according to Australian researchers.


Writing in Obesity Reviews, they examined the perspectives of both PCPs and patients in post-bariatric surgery care provided by PCPs and synthesised themes from qualitative research to recommend improvements in post-bariatric surgery clinical care in primary care settings.


The identified seven themes including stigma and judgment; clinician barriers and facilitators; patient-related support needs; communication considerations; patient context or determinants; health care setting; and adapting to life after surgery.


PCPs reported barriers including poor communication and guidance from bariatric surgery centres, limited knowledge and training in bariatric patient care, and patients who may have unrealistic outcomes and poor health literacy.


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Comparative Study for Safety and Efficacy of OAGB and SADJB-SG: A Retrospective Study   

Although one anastomosis gastric bypass (OAGB) and single anastomosis duodeno-jejunal bypass with sleeve gastrectomy (SADJB-SG) are reliable in terms of safety and efficacy, and while OAGB has reduced operational expenses, SADJB-SG offers a broader range of applicability, according to researchers from Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, China.


Writing in Dove Press, in total of 63 patients completed two-year follow-up, the excess weight loss percentage (EWL%) for the OAGB and SADJB-SG was 73.970±5.005 and 75.652±7.953, respectively (p=0.310); total weight loss percentage (TWL%) was 24.006±8.231 and 23.171±6.600, respectively (p=0.665).


Diabetes remission rates for the two groups were 71.429% and 69.048%, respectively (p=0.846). The cost for OAGB was 55088.208±1508.220 yuan, which was significantly lower than the 57538.195±1374.994 yuan for SADJB-SG (p<0.001).


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