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Journal Watch 3/07/2024

 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 OAGB for reflux post-SG, cognitive deficits after adolescent bariatric surgery, impact CKD on metabolic surgery outcomes and bariatric surgery results in an unfavourable increase in bone turnover markers, and more (please note, log-in maybe required to access the full paper).

Modified One Anastomosis Gastric Bypass Following Sleeve Gastrectomy for Severe Reflux and Delayed Gastric Emptying: A Prospective Trial with Clinical and Physiological Outcome Measures

One-anastomosis gastric bypass is an effective treatment for reflux associated with delayed gastric emptying post- sleeve gastrectomy (SG), according to researchers from Monash University, Melbourne, Australia.

Reporting in Obesity Surgery, they sought to determine whether OAGB performed for reflux post-SG accelerates gastric emptying half-time, reduces the frequency and severity of reflux events and improves reflux symptoms. In total, 22 participants (90.9% female, age 44.4 years) who underwent measurement before and after revisional surgery with 29 optimal SG (patients with optimal outcome from their primary surgery) as controls.

Conversion from SG to OAGB was at a median of 45.2 ± 19.6 months. Scintigraphy showed an increased rate of gastric emptying post-OAGB 34 (IQR 14) vs 24 (IQR 10.3) min (p=0.008), with decreased number of reflux events post-prandially (39 (IQR 13) vs 26 (IQR 7), p=0.001). This data correlated with the pH analysis; total acid events substantially reduced post-OAGB 58.5 ((IQR 88) vs 12 (IQR 9.4) events, p=0.017). Endoscopic findings indicated a reduction in incidence of bile stasis 72.7% vs 40.9% post-OAGB (p<0.00010). Post-OAGB, patients experienced less frequent regurgitation (12 ± 4.1 vs. 5.5 ± 3, p=0.012) and reflux (37.1 ± 15.7 vs. 16.8 ± 12.6, p=value 0.003).

The authors suggested that the likely mechanisms is by an increase in the rate of gastric clearance and reduced reflux events and overall oesophageal acid exposure, indicating that some forms of post-SG reflux are driven by slower emptying of the residual stomach and are amenable to treatment with drainage above the incisura.

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Cognitive function 10 years after adolescent bariatric surgery

Cognitive deficits are common ten years after adolescent bariatric surgery, according to US researchers writing in SOARD.

The study included 99 young adults who underwent bariatric surgery as adolescents and who completed a computerised cognitive test battery as part of a larger ten-year postoperative assessment. All the participants had been long-term participants in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study.

They report that cognitive dysfunction was prevalent on tests of attention and executive function  and 53.5% met research criteria for mild cognitive impairment (MCI). Participants with preoperative hypertension and those completing Roux-en-Y gastric bypass were more likely to meet criteria for MCI at ten-year follow-up.

The researchers noted that additional studies are needed to clarify possible cohort effects, determine whether these cognitive deficits persist to even later follow-up and identify underlying mechanisms and mitigation strategies.

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Impact of Progressive Chronic Kidney Disease Stage on Post Operative Outcomes in Metabolic Surgery—A Propensity Matched Analysis utilizing the MBSAQIP Database

Chronic kidney disease (CKD) stage III is a major inflection point for risk of length of stay (LOS) >5 days, infection, serious complications and major adverse cardiovascular events (MACE), according to researchers from Louisiana State University School of Medicine, New Orleans, LA.

Reporting in SOARD and using data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database (2017-2021), they identified 688,583 patients (483,898 without CKD and 204,685 with CKD stages I-V). Both SG and RYGB exhibited linear increase in risk of infection and death. For SG, Stage IIIa/IIIb patients demonstrated the highest risk for LOS > 5 days (OR (95% CI) 1.23 (1.05,1.45); p=0.011), serious complications (OR (95% CI) 2.83 (1.87,4.30); p<0.001) and MACE (OR (95% CI) 2.82 (1.81,4.37); p<0.001). For RYGB, stage IIIa/IIIb patients exhibited highest risk of MACE (OR (95% CI) 1.67 (1.06,2.62); p=0.027).

The researchers concluded that the findings are useful for counselling and procedure selection, suggesting a need for heightened attention to CKD stage III patients undergoing metabolic surgery.

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Comparing sexual self-concept in women with obesity pre- and post-bariatric surgery

In general, bariatric surgery can improve sexual self-care and considering the issue of sexual self-concept in bariatric surgery, researchers from Shahid Beheshti University of Medical Sciences, Tehran, Iran, recommend appropriate counselling and planning before surgery according to the culture of each country.

Writing in BMC Public Health, their longitudinal study compared sexual self-concept pre and post-surgery on women with obesity referring to obesity clinics in the city of Tehran in 2020–2021. Data collection was performed using Snell’s Multidimensional Sexual Self-Concept Questionnaire (MSSCQ), which was completed online.

According to the findings, the mean (standard deviation) score of sexual self-concept was 240.26 (26.82) in the post-surgery group and 200.26 (32.24) in the pre-surgery group (p=0.001), and the highest mean (standard deviation) score of sexual self-concept both in the pre-surgery group (13.06 [4.00]) and in the post-surgery group (15.46 [2.16]) was related to the area of sexual depression (p=0.05).

With increasing educational level, the odds of bariatric surgery increased by 33% and those who had no private bedroom had lower odds of bariatric surgery by 65%.

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Changes in bone turnover markers 6–12 months after bariatric surgery

Bariatric surgery results in an unfavourable increase in bone turnover markers (BTM), emphasising the importance of optimal prophylactic interventions after bariatric surgery to prevent osteoporosis, a researcher from Innlandet Hospital Trust, Brumunddal, Norway, has reported in Scientific Reports.

The study examined the factors associated with BTM and changes in BTM after bariatric surgery and included 104 subjects (women 83, mean age 43.1 (SD 8.4) years; BMI: 38.8 kg/m2). Surgery with Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) was performed in 84 (81%) and 20 (19%) subjects, respectively. From before to 6–12 months after surgery, procollagen type 1 N-terminal propeptid (P1NP) increased by 45.6µg/L (95% CI 41.5–50.0, p<0.001) and alkaline phosphatase (ALP) by 10 U/L (95% CI 7–14, p<0.001). The increases were significantly larger after RYGB than after SG.

The APOE- Ɛ3 allele was associated with low levels of BTM and high levels of leptin and SG compared to RYGB and the presence of the APOE-Ɛ3 allele were associated with less unfavourable effects.

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