Journal Watch 26/05/2022

Updated: Jun 8

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 study reporting on obesity and eligibility for obesity treatments for adults with disabilities, artificial intelligence-based model can predict de novo GERD post-LSG, vaccinations may be beneficial for patients against COVID-19 prior to bariatric surgery and surgical technique for construction of JJ may affect the incidence of SBO post-RYGB (please note, log-in maybe required to access the full paper).


Obesity and Eligibility for Obesity Treatments Among Adults With Disabilities in the U.S.

US researchers, writing in the American Journal of Preventative Medicine, have assessed the prevalence of obesity and eligibility for anti-obesity pharmacotherapy and/or bariatric surgery in adults with disability.


The study included 29,170 community-dwelling adult respondents (59.1% response), the overall prevalence of disability was 10%. The prevalence of obesity among adults with a disability was 40.1% vs 30.5% for US adults overall (p<0.0001). An estimated 17.1% with disability met the criteria for both bariatric surgery and antiobesity pharmacotherapy; another 39.8% were eligible for pharmacotherapy alone (vs 7.9% and 33.2%, respectively, for adults overall; p<0.0001). In fully adjusted models, disability was associated with greater ORs for mild obesity (OR=1.2; 95% CI=1.1, 1.4), moderate‒severe obesity (OR=2.1; 95% CI=1.8, 2.3), and criteria for bariatric surgery (OR=2.4; 95% CI=2.1, 2.7) and pharmacotherapy (OR=1.3; 95% CI=1.2, 1.4).


Mobility, self-care, and cognition disabilities were associated with eligibility for bariatric surgery and antiobesity pharmacotherapy. They concluded that comorbidities should be considered, accommodations should be provided and insurance coverage should be expanded to ensure access to antiobesity treatments for adults with disabilities.


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Development and Validation of an Artificial Intelligence-Based Model to Predict Gastroesophageal Reflux Disease After Sleeve Gastrectomy

Investigators from Mansoura University Hospitals, Mansoura University, Mansoura, Egypt, sought to develop an artificial intelligence (AI)-based model to predict the onset of de novo gastroesophageal reflux disease (GERD) after sleeve gastrectomy (SG) to help clinicians and surgeons in decision-making.


A prospectively maintained database of patients with severe obesity who underwent SG was used for the development of the AI model using all the available data points. The dataset was arbitrarily split into two parts: 70% for training and 30% for testing.


In total, 441 patients (76.2% female) of a mean age of 43.7 ± 10 years were included. The ensemble model outperformed the other models. The model achieved an AUC of 0.93 (95%CI 0.88–0.99), sensitivity of 79.2% (95% CI 57.9–92.9%), and specificity of 86.1% (95%CI 70.5–95.3%). The top five ranked predictors were age, weight, preoperative GERD, size of orogastric tube, and distance of first stapler firing from the pylorus.


Writing in Obesity Surgery, the researchers concluded that the model had excellent accuracy, yet a moderate sensitivity and specificity. Further prospective multicentre trials are needed to externally validate the model developed.


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Incidence and presentation of COVID-19 in the vaccinated and unvaccinated patients undergoing bariatric surgery

Researchers from Egypt and The Netherlands, writing in Obesity Pillars, have concluded that vaccinations may be beneficial for patients against COVID-19 prior to bariatric surgery. Their study was designed to describe the incidence and clinical presentation of fully vaccinated and unvaccinated patients who tested positive for COVID-19 in the first year after Madina Women’s Hospital in Alexandria, Egypt, resumed bariatric surgery procedures.


During the one year after the restart of bariatric surgery procedures, 606 patients underwent bariatric procedures (n=280 fully vaccinated, n=320 unvaccinated). During follow-up, that period, the incidence of COVID-19 in the vaccinated group was 1.07% (n =3) vs 14.1% (n=46) in the unvaccinated group.


Three patients had mild symptoms in the vaccinated group, and no hospital admission was necessary. In the unvaccinated group, 27 patients (60%) were classified as mild, eight (17.8%) as moderate, eight (17.8%) as moderate with risk, and two (4.4%) as severe; the mortality rate was 0%. Of these, 16 (88.9%) were hospitalised, of which six (33.3%) were admitted to the intensive care unit in the moderate to severe groups.


Their findings showed a higher incidence of COVID-19 among those unvaccinated versus vaccinated, and therefore, at least during times and locations of a COVID-19 pandemic, vaccinations may be beneficial for patients against COVID-19 prior to bariatric surgery.


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Surgical Technique in Constructing the Jejuno-jejunostomy and the Risk of Small Bowel Obstruction after Roux-en-Y Gastric Bypass

Investigators from Sweden, reporting in SOARD, have concluded that the surgical technique for construction of the jejuno-jejunostomy (JJ) may affect the incidence of small bowel obstruction (SBO) after laparoscopic Roux-en-Y gastric bypass (RYGB).


The researchers analysed outcomes from 23,448 patients and in their multivariate analysis bidirectional stapling of the JJ was associated with a reduced 30-day risk of SBO (p<0.05), whereas limited mesenteric division (1–4 cm) increased the risk of SBO (p<0.01). The long-term incidence of SBO was increased by bidirectional stapling but unaffected by mesenteric division.


However, mesenteric division decreased the long-term risk of SBO in patients with a bidirectionally stapled JJ (1–4 cm, p<0.05; ≥5cm, p<0.005).


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