Journal Watch 27/09/2023

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 the management of hyperglycaemia in type 2 diabetes, women’s reasons to seek bariatric surgery, outcomes with direct acting oral anticoagulants in patients with a history of bariatric surgery, the operative management of acute abdomen after bariatric surgery in the emergency setting and bariatric surgery and secondary hyperparathyroidism (please note, log-in maybe required to access the full paper).


Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

Reported in Diabetes Care, the American Diabetes Association and the European Association for the Study of Diabetes have provided a consensus statements on the management of hyperglycaemia in type 2 diabetes in adults, which was last updated in 2019.


A systematic examination of publications since 2018 informed new recommendations and included additional focus on social determinants of health, the health care system and physical activity behaviours, including sleep.


The authors noted that there is a greater emphasis on weight management as part of the holistic approach to diabetes management. The results of cardiovascular and kidney outcomes trials involving sodium–glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists, including assessment of subgroups, inform broader recommendations for cardiorenal protection in people with diabetes at high risk of cardiorenal disease.


After a summary listing of consensus recommendations, the authors provided practical tips for implementation.


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Women’s Reasons to Seek Bariatric Surgery and Their Expectations on the Surgery Outcome — a Multicenter Study from Five European Countries

European researchers have reported women seek bariatric surgery for weight loss and improved co-morbidities. While expectations on weight loss were generally very high, expectations of surgery vs. lifestyle as the main driver of weight loss differed between countries.


Reporting in Obesity Surgery, examined the reasons for seeking bariatric surgery and expectations of surgical outcomes in 250 patients - 50 women each from Finland, Germany, Norway, Sweden and the Netherlands. Participants ranked 14 reasons for seeking surgery and reported the three primary reasons. They also reported expectations on weight loss and impact of surgery vs. lifestyle on weight loss outcomes.


Participants expected to lose between 70.8 and 94.3% of their excessive weight. The expected impact of surgery as a driver of weight loss was higher in Germany and the Netherlands compared to in Finland, Norway, and Sweden where participants expected lifestyle changes to also have an impact.


“While some patients understand the importance of lifestyle change and maintenance of a healthy lifestyle after surgery in order to obtain a successful weight loss, other may need additional counselling,” the researchers concluded.


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Outcomes with direct acting oral anticoagulants in patients with a history of bariatric surgery: a retrospective cohort study

Researchers from the University of Minnesota College of Pharmacy, Minneapolis, MN, writing in SOARD, have reported in bariatric surgery patients receiving direct acting oral anticoagulants (DOACs clotting rates consistent with expected rates and bleeding rates above expected rates based on historical data. They also found an increased risk of bleeding in rivaroxaban users as compared with apixaban users.


Their retrospective cohort study included 191 adult patients with a history of bariatric surgery who were prescribed a DOAC for the prophylaxis or treatment of venous thromboembolism (VTE) or for stroke and systemic embolism prevention in atrial fibrillation between January 2011 to December 2018.


Clotting events occurred in 11 out of 191 patients (5.8%) while receiving DOAC therapy, with a calculated clotting rate of 3.9 clots per 100 person years. Bleeding events occurred in 42 out of 191 patients (22%) while receiving a DOAC, with a calculated bleeding rate of 17.1 bleeds per 100 person years. The use of rivaroxaban versus apixaban was associated with a statistically significant increased risk of bleeding in patients with a history of bariatric surgery.


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Operative management of acute abdomen after bariatric surgery in the emergency setting: the OBA guidelines

An international team of researchers have concluded that close collaboration between emergency surgeons, radiologists, endoscopists and anaesthesiologists is mandatory in the management of acute abdomen after bariatric surgery in the emergency setting.


Reporting in the World Journal of Emergency Surgery, the authors contacted members of the World Society of Emergency Surgery and experienced IFSO bariatric surgeons to provide evidence-based guidelines and a consensus position on the management of acute abdomen after bariatric surgery. The paper focuses on long-term complications in patients who have undergone laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB).


A working group of experienced general, acute care, and bariatric surgeons was created to carry out a systematic review of the literature following the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) and to answer the PICO questions formulated after the Operative management in bariatric acute abdomen survey. The literature search was limited to late/long-term complications following laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass.


“Knowledge of the most common late/long-term complications (> 4 weeks after surgical procedure) following LSG and LRYGB and their anatomy leads to a focused management in the emergency setting with good outcomes and decreased morbidity and mortality rates in a multidisciplinary approach,” the researchers concluded.


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Bariatric surgery and secondary hyperparathyroidism: a meta-analysis

Researchers from the Second Xiangya Hospital of Central South University, Changsha, Hunan, China, have reported that gastric bypass appears to increase secondary hyperparathyroidism (SHPT) and that patients undergoing metabolic and bariatric surgery (MBS) should be aware of the risk of SHPT.


Their meta-analysis examines the impact of MBS on the risk of SHPT, which included nine studies (5,585 patients). The mean follow-up time was 3.5 years (range 0.25-5). They reported that MBS does not appear to affect SHPT risk. Follow-up data showed no evidence of SHPT within two years following gastric bypass (GB) and sleeve gastrectomy (SG) procedures. However, at the two-year and long-term follow-up intervals, a marked increase in SHPT was detected for GB. In addition, the surgical procedure for GB decreased the likelihood of SHPT compared with the surgical procedure for biliopancreatic diversion with duodenal switch.


They concluded that larger studies are needed to evaluate the outcomes and side effects and may eventually provide a better and more comprehensive understanding of the risks.


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