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Journal watch 29/03/2023

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 PCORnet Bariatric Study findings, TXA reduces post-LSG bleeding, impact of UDCA on ERCP rates post-LSG, bariatric surgery and microvascular outcomes, combination of exercise and liraglutide improved glucose tolerance, beta cell function, and glucagon responses after weight loss and more (please note, log-in maybe required to access the full paper).

Preoperative Depression Status and 5 Year Metabolic and Bariatric Surgery Outcomes in the PCORnet Bariatric Study Cohort

Collaborators from the PCORnet Bariatric Study have reported that patients with depression undergoing RYGB and SG had similar weight loss, diabetes, and safety/utilization outcomes to those without depression.

Writing in the Annals of Surgery , they investigated whether depression status before metabolic and bariatric surgery (MBS) influenced five–year weight loss, diabetes, and safety/utilisation outcomes in the PCORnet Bariatric Study. The study included 36,871 patients who underwent sleeve gastrectomy (SG; n=16,158) or gastric bypass (RYGB; n=20,713). In total, 27.1% of SG and 33.0% of RYGB patients had preoperative depression, and 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 (p=0.04). However, patients with depression had slightly larger HbA1c improvements after RYGB but not after SG (p=0.04).

They concluded the effects of depression were clinically small compared to the choice of operation.

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Role of Tranexamic Acid (TXA) in Preventing Bleeding Following Sleeve Gastrectomy: a Systematic Review and Meta-analysis

Intravenous tranexamic acid (TXA) at the time of laparoscopic sleeve gastrectomy is associated with a significant reduction of post-operative bleeding with no observed differences in thromboembolic events or mortality, Canadian researchers have found.

In their systematic review and meta-analysis, reported in Obesity Surgery, they identified four studies (475 patients), 207 received TXA at induction and all underwent laparoscopic sleeve gastrectomy (LSG).

Post-operative bleeding after LSG ranged from 0 to 28% depending on bleed definition and TXA administration with no differences in venous thromboembolic events or mortality between groups. Meta-analysis of post-operative bleeding demonstrated a statistically significant benefit with TXA administration (p= 0.001) for patients undergoing elective LSG.

The researchers cautioned that additional high-quality studies are needed to better delineate the ideal bariatric population to receives TXA in addition to the optimal timing, dose and duration of TXA therapy.

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Ursodeoxycholic acid for prevention of gallstone disease after laparoscopic sleeve gastrectomy: an Atlantic Canada perspective

Canadian investigators have found lower rates of endoscopic retrograde cholangiopancreatography (ERCP) in patients receiving routine ursodeoxycholic acid (UDCA) following laparoscopic sleeve gastrectomy (LSG).

Reporting in Surgical Endoscopy, they performed a retrospective chart review of 461 patients who underwent LSG at two care centres. At one centre, UDCA 250mg oral twice daily was routinely prescribed following LSG for six months to 303 patients with an intact gallbladder. At the other centre, UDCA was not prescribed to 158 patients.

They found that the cholecystectomy rate was not significantly associated with UDCA administration, however there was a trend towards less cholecystectomy in patients who received UDCA (8.3% vs. 13.9%, p=0.056). The ERCP rate was significantly lower in patients who received UDCA (0.3% vs 2.5%, p=0.031). Rate of gallstone disease requiring intervention, either cholecystectomy or ERCP, was significantly decreased in patients who received UDCA (8.9% vs 15.8%, p=0.022). Cost (45.4%) and nausea (18.1%) were the most common barriers to compliance with UDCA.

“Our findings support the ASMBS 2019 guidelines for administering UDCA after LSG for preventing gallstone disease,” the authors concluded.

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Benefits of bariatric surgery on microvascular outcomes in adult patients with type 2 diabetes- A Systematic review and meta-analysis

Researchers at the Universidad Autónoma de Nuevo León, Monterrey, México, have reported bariatric surgery in adult patients with diabetes reduced the odds of any stage of retinopathy, haemodialysis/end-stage renal disease (HD-ESRD) and nephropathy composite outcome.

They identified 25 studies (160,072 participants) and the pooled analysis revealed surgery reduces the incidence of any stage of retinopathy by 71%, nephropathy incidence by 59 and HD-ESRD by 69%.

Surgery also increased the odds of albuminuria regression by 15.15, however higher odds of retinopathy regression were not observed. There were no statistically significant differences between groups regarding the change in surrogate outcomes.

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Weight loss maintenance with exercise and liraglutide improves glucose tolerance, glucagon response, and beta cell function

A team led by researchers from the University of Copenhagen, Denmark, have found only the combination of exercise and liraglutide improved glucose tolerance, beta cell function and glucagon responses after weight loss.

In this randomised placebo-controlled trial 195 adults with obesity without diabetes underwent an eight-week low-calorie diet (800 kcal/d) and were randomised to 52 weeks of aerobic exercise, liraglutide 3.0mg/d, exercise and liraglutide combined or placebo.

One-year after treatment, the combination group had decreased postprandial glucose response by −9% (p=0.002), improved beta cell function by 49% (p=0.002) and decreased glucagon response by −18% (p=0.024) vs placebo. Compared with placebo, liraglutide alone improved postprandial glucose response by −7% (p=0.018), but not beta cell function or glucagon. Exercise alone had similar postprandial glucose response, beta cell function, and glucagon response as placebo.

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