Journal watch 3/12/2025

Welcome to our regular 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 FundoRing-OAGB modification, magnet-assisted bariatric surgery, Bariclip, ring-augmented sleeve gastrectomy and the SURMOUNT-4 Trial, and more (please note, log-in maybe required to access the full paper).

Comparative endoscopic ultrasound assessment of the gastric pouch after FundoRing-OAGB and OAGB

Researchers from Astana Medical University, Astana, Kazakhstan, have concluded that the FundoRing-OAGB modification exerted a significant anti-dilatation effect on the gastric pouch.

Writing in BMC Surgery, they assessed the FundoRing modification of OAGB (FundoRing-OAGB) that incorporates the excluded stomach in a primary fundoplication to see whether it limits reflux and weight regain by exerting an anti-dilatation effect on the gastric pouch.

This comparative prospective post-hoc sub-study included 50 patients (25 per group) randomly selected from participants in a precursor randomised controlled trial (RCT). The sub-study aimed to assess and compare the anatomical integrity and volumetric parameters of the gastric pouch at 1 and 3 years using endoscopic ultrasound (EUS) in patients who had undergone OAGB with, or without, the FundoRing modification. Measurements included pouch diameter, volume, and wall thickness.

At 3 years, patients in the FundoRing-OAGB group (n=21) had significantly lower pouch diameters (2.8 ± 0.23 cm vs. 3.41 ± 0.4 cm, p=0.014) and volumes (60.39 ± 10.04 mL vs. 87.93 ± 25.79 mL, p<0.001) compared to the OAGB group (n=20). In the FundoRing-OAGB group, at year 3, pouch volume had increased 36.25% vs. an increase of 74.33% in the OAGB group (p<0.001). Wall thickness and pouch length did not differ significantly.

“This effect may potentially correlate with better long-term weight maintenance; however, these clinical outcomes were not assessed in the present study. Large studies with long-term follow-up are needed to validate these findings and assess their clinical impact,” they concluded.

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Current evidence and future perspectives on magnet-assisted bariatric surgery (MABS): a systematic review

Chinese researchers have found that magnet-assisted bariatric surgery (MABS) demonstrates strong potential as an innovative tool in minimally invasive bariatric surgery, offering significant benefits for both patients and surgical teams. They added that Its ability to address obesity-related challenges and enhance surgical outcomes supports its continued use and refinement.

Reporting in the International Journal of Obesity, this systematic review aimed to: (1) compare the efficacy of MABS and conventional bariatric surgery for weight loss and postoperative outcomes; (2) assess their safety profiles; and (3) evaluate perioperative recovery, hospital stay, and patient-reported outcomes like quality of life and satisfaction.

A total of 12 articles comprising 1305 participants were included. The findings confirmed MABS’s feasibility and safety, with significant advantages across varying BMI ranges. Notable benefits included improved surgical exposure, shorter or comparable operative times, reduced postoperative pain, shorter hospital stays, low complication rates and no procedure-related mortality.

“Future research should focus on stratified analyses, long-term outcomes, and economic evaluations to establish standardized criteria for patient selection and expand its applicability to other minimally invasive procedures,” they concluded.

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Retrospective analysis of the BariClip procedure: Clinical outcomes and complication profile

Researchers from Jordan have reported that Bariclip surgery demonstrates favourable short-term safety and efficacy, with substantial weight loss and low complications rate observed within six months.

Published in PLOS One, they evaluate short-term surgical outcomes, weight loss metrics, and comorbidity resolution among patients undergoing Bariclip implantation.

This retrospective observational study included 82 patients who underwent Bariclip placement at a single tertiary care centre. The cohort had a mean age of 37.6 ± 9.9 years, with the majority being female (76.8%) and obese (mean BMI = 36.6 ± 4.7 kg/m²). Most patients (91.5%) underwent surgery for obesity management. Postoperatively, patients reported low pain scores (mean=5.2), with no need for opioid analgesia and early mobilization in 62.2%. Complication rates were low (3.6%).

Repeated measures ANOVA revealed a significant reduction in BMI over time (p < 0.001). At 6 months, mean %TWL was 20.04% ± 5.39% and mean %EWL reached 74.32% ± 40.75%. The most rapid weight loss occurred during the first three months, followed by a slower but consistent decline thereafter.

“These findings support Bariclip as a promising minimally invasive option for weight management in select patient populations,” they concluded.

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Evaluating The Impact of Ring Augmentation In Sleeve Gastrectomy: A Retrospective Propensity-weighted Cohort Study

Researchers from Egypt have found that ring-augmented sleeve gastrectomy (RASG) provides more durable weight loss without added morbidity compared to non-ring-augmented sleeve gastrectomy (NRASG).

Writing in BMC Gastroenterology, this retrospective propensity-weighted cohort study compared outcomes of RASG and NRASG over two years in patients with morbid obesity. A total of 1,392 SG cases performed between 2021 and 2022 were reviewed, and after propensity score weighting, 132 RASG and 125 NRASG patients were analysed.

They found that RASG was associated with significantly higher total and excess weight loss at two years (TWL: 47.4% vs. 38.5%; EWL: 102.8% vs. 82.0%; p<0.001) and a complete absence of RWG, compared to a 5.6% recurrence rate in the NRASG group. Comorbidity resolution rates and nutritional deficiencies were similar across groups, while ring-related complications were rare and manageable. Endoscopic evaluation at one year showed no significant difference in GERD incidence.

The said that further prospective studies incorporating patient-reported outcomes and physiologic assessments are warranted to validate long-term benefits and safety.

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Cardiometabolic Parameter Change by Weight Regain on Tirzepatide Withdrawal in Adults With Obesity - A Post Hoc Analysis of the SURMOUNT-4 Trial

In this post hoc analysis of the SURMOUNT-4 trial, an international team of researchers has reported among participants with obesity who achieved weight reduction with 36-week tirzepatide treatment, withdrawing tirzepatide led to 25% or greater weight regain in most participants within 1 year and was associated with a greater reversal of their initial cardiometabolic parameter improvements compared with those who maintained weight reduction.

Published in JAMA Internal Medicine, the study assessed changes in cardiometabolic parameters by degree of weight regain after withdrawal of tirzepatide. Of 308 included participants, 219 (71.1%) were female, 89 (28.9%) were male, and the mean (SD) age was 47.1 (12.2) years. There were 54 participants in the less than 25% weight regain group, 77 in the 25% to less than 50% group, 103 in the 50% to less than 75% group, and 74 in the 75% or more group. During the initial 36 weeks of tirzepatide treatment, participants’ weight decreased and cardiometabolic parameters improved.

After withdrawal of tirzepatide, from week 36 to week 88, the mean change in waist circumference increased by weight regain category (<25% weight regain, 0.8 cm; 95% CI, −1.0 to 2.6; 25% to <50%, 5.4 cm; 95% CI, 4.0-6.8; 50% to <75%, 10.1 cm; 95% CI, 8.9-11.3; ≥75%, 14.7 cm; 95% CI, 12.7-16.7; P < .001), as did systolic blood pressure (6.8 mm Hg [95% CI, 3.9-9.7], 7.3 mm Hg [95% CI, 4.8-9.8], 9.6 mm Hg [95% CI, 7.1-12.1], and 10.4 mm Hg [95% CI, 8.0-12.8], respectively; p=0.002), non–high-density lipoprotein cholesterol (−0.4% [95% CI, −7.3 to 6.5], 1.6% [95% CI, −2.3 to 5.5], 8.4% [95% CI, 3.9-12.9], and 10.8% [95% CI, 5.3-16.3], respectively), haemoglobin A1c (0.14% [95% CI, 0.06-0.22], 0.15% [95% CI, 0.09-0.21], 0.27% [95% CI, 0.21-0.33], and 0.35% [95% CI, 0.29-0.41], respectively; P < .001), and fasting insulin (−4.0% [95% CI, −20.7 to 12.7], 15.4% [95% CI, 2.3-28.5], 46.2% [95% CI, 29.5-62.9], and 26.3% [95% CI, 9.6-43.0], respectively). Changes at week 88 in waist circumference, non–high-density lipoprotein cholesterol, and fasting insulin in those with less than 25% weight regain were not significantly different compared with week 36.

The authors said these findings underscore the importance of continued obesity treatment.

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