Journal Watch 30/7/2025

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 five-year SADI-S outcomes, first-in-human side-to-side duodenoileal bipartition, cost-effectiveness analysis of behavioural, pharmacological, and surgical obesity treatments , five-year clinical outcomes of RefluxStop , magnetic sphincter augmentation in patients 65 years, lack of evidence for obesity paradox, and more (please note, log-in maybe required to access the full paper).

Five-Year Outcomes of Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy: A Systematic Review

Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S) appears to be an effective bariatric procedure, providing sustained weight loss and acceptable complication rates at 5 years, according to a study led by researchers from the Hospital de Sant Joan Despí Moisès Broggi, Barcelona, Spain. However, they noted nutritional risks - particularly those related to protein malnutrition - highlight the importance of structured postoperative monitoring.

Reporting in Obesity Surgery, their systematic review assessed the five-year outcomes of SADI-S performed as a primary bariatric procedure, focusing on weight loss, morbidity, mortality, and complications.

The review included 1,088 patients across four centres. The mean preoperative BMI was 49.66 kg/m2, with women representing 64% of the cohort. At five years, follow-up data were available for 326 patients. The procedure resulted in sustained weight loss, with a mean total weight loss of 33.67% and excess weight loss of 72.88%, resulting in a mean BMI of 31.7 kg/m2. Short-term complication rates ranged from 5.4% to 11.6%, while long-term complications ranged from 8.7% to 17.9%. Interestingly, malnutrition-related reoperations were associated with a common channel length of 200 cm.

Further prospective studies are needed to validate these findings and guide surgical decision-making, they concluded.

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First-in-Human Side-to-Side Duodenoileal Bipartition for Weight Loss and Type 2 Diabetes with the Swallowable Biofragmentable Magnetic Anastomosis System

Researchers from Canada and the Republic of Georgia have found the swallowable, biofragmentable magnetic anastomosis system (BMAS) was feasible, safe and effective in achieving incisionless, suture- or staple-free magnetic duodenoileostomy (MagDI) bipartition.

Writing in the Journal of the American College of Surgeons, this is a first-in-human prospective investigation of feasibility, safety, and efficacy in adults with BMI 30.0 or more to 35.0 or less kg/m2. Primary endpoints are feasibility and severe adverse event (AE) incidence by Clavien-Dindo grade. Secondary endpoints are weight and T2D reduction.

Between December 22022 and May 2024, 15 patients (mean BMI 33.0 ± 0.4 kg/m2), all with T2D (glycosylated hemoglobin 8.2% ± 0.4%, glucose 187.9 ± 15.5 mg/dL, on T2D medications) underwent MagDI. Feasibility at 90 days was confirmed in 100.0% with 0.0% leakage, bleeding, infection, stricture, and mortality; 89.4% of AEs were mild; and 3 Clavien-Dindo-III severe AEs were resolved. At one year, 100.0% of anastomoses were patent, BMI was (8) 30.1 ± 0.9 kg/m2, excess weight loss was 38.8%, glycosylated hemoglobin was 6.6% ± 0.1%, and glucose was 142.8 ± 9.5 mg/dL.

The researchers concluded the device and procedure provide a promising minimally invasive option for moderate, clinically meaningful weight loss and T2D mitigation.

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A cost-effectiveness analysis of behavioural, pharmacological, and surgical obesity treatments in Canada

Investigators from McGill University, Montreal, Quebec, Canada have reported Roux-en-Y gastric bypass (RYGB) and health behaviour intervention (HBI) are cost-effective for managing class III obesity, but while RYGB provided the greatest health gains access remains limited.

Writing in the journal Diabetes, Obesity and Metabolism, they evaluated the cost-effectiveness of sleeve gastrectomy (SG), RYGB, semaglutide, tirzepatide and HBI compared to no treatment, in preventing cardiometabolic complications among Canadian adults with class III obesity. Outcomes included incremental cost-effectiveness ratios (ICERs) evaluated at a C$50,000/QALY willingness-to-pay threshold.

HBI was cost-effective versus no treatment (ICER $14,279/QALY) with RYGB demonstrating the highest QALYs (20.20) and was the most cost-effective strategy versus tirzepatide (ICER $44,667/QALY). Semaglutide and SG were strongly dominated due to higher costs and lower effectiveness. Tirzepatide was extendedly dominated by RYGB. Sensitivity analyses confirmed these findings and showed that lower drug prices could improve pharmacotherapy cost-effectiveness.

Neither pharmacotherapy was cost-effective at current prices, although the researchers noted that lower drug prices could significantly improve pharmacotherapy cost-effectiveness.

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Five-year clinical outcomes of RefluxStop surgery in the treatment of acid reflux: a prospective multicenter trial of safety and effectiveness

Researchers from Hungary have reported that the RefluxStop procedure demonstrated exceptional long-term five-year outcomes with both median GERD-HRQL scores and mean 24-h pH results improving by > 90% from baseline (p=0.001).

Reporting in Surgical Endoscopy,  this prospective, single-arm, multicentre clinical study was conducted to investigate RefluxStop surgery in 50 adults with chronic GERD, PPI use, GERD-HRQL score, 24-h pH testing, contrast-swallow x-ray, and serious/non-serious AEs presented.

Forty-four patients completed five-year follow-up, with 91% undergoing pH testing and contrast-swallow x-ray. PPI usage was 1/47 (2.1%). The median (IQR) total GERD-HRQL score improved by 90% (72–98%) from a baseline of 29.5 (33.0–24.0) to 3.0 (0.5–7.5) at 5 years (p<0.001) and 24-h pH monitoring results improved by 90.4% to a mean total acid exposure time (pH < 4) of 1.57% from 16.35% at baseline (p<0.001).

There were no cases of device explantation, migration/erosion or oesophageal dilatation occurred during the study. Five-year contrast-swallow x-ray showed zero (0%) dislocations, migrations, or re-herniations. Five patients experienced serious AEs of which all were resolved. Only two procedure-related AEs occurred between one and five years, one moderate dyspepsia and one mild dysphagia, subsequently resolved.

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Is Magnetic Sphincter Augmentation as Effective in Patients Who Are 65 Years and Older as in Younger Patients?

Magnetic sphincter augmentation (MSA) is beneficial among GERD patients ≥65, with improvement in symptoms of regurgitation and health-related quality of life (HRQL), dissatisfaction and PPI use at 33 to six months and ≥ one year, investigators from Broward Health Coral Springs, Coral Springs, FL, have found.

Writing in Foregut, the researcher sought to determine if MSA can comparably improve symptoms in those 65+ years. This is a retrospective cohort study including patients undergoing MSA (n = 98) from October 2016 to September 2022.

They found that there were no significant differences by age group (p>0.05) at 3 to 6 months or ≥1 year in postoperative dysphagia, regurgitation, HRQL, dissatisfaction, and PPI usage. There were significant improvements from preoperative to 3 to 6 months and to ≥1 year postoperatively (p<0.001 for all but dysphagia). For dysphagia significant improvement was observed preoperatively to 3 to 6 months in <65 (p=0.003) but not at 1+ years (p=0.068) but in the 65+ group no differences were observed from pre-to-postoperatively for either timepoint (p=0.133 and p=0.657, respectively). Patients ≥65 had significantly larger hiatal hernias than those <65 (p=0.012).

The authors concluded that since these improvements are not age-based differences, MSA can equally be used in patients ≥65 years.

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Lack of evidence for obesity paradox in patients with cardiovascular disease: A UK BioBank cohort study

Researchers from Shandong University, Jinan, China, have reported that increased obesity does not show a protective effect in patients with cardiovascular disease (CVD) and previously reported obesity paradox in observational studies may be a result of confounding or other biases.

Writing in the journal Diabetes, Obesity and Metabolism, the study authors sort to examine the presence of the obesity paradox using body fatness (body fat percentage, BF%) and central obesity (waist-to-hip ratio adjusted for BMI, WHRadjBMI).

A total of 85,926 participants with CVD from the UK Biobank were included. Prospective associations of BMI, BF% and WHRadjBMI with CVD mortality in these patients were examined. Polygenic risk scores (PRSs) for BMI, BF% and WHRadjBMI were used as instrumental variables in Mendelian randomisation analyses.

A total of 5432 patients died of CVD causes during a median follow-up period of 13.6 years. BMI in the overweight and class-I obesity ranges was associated with reduced mortality, with class-II or more severe obesity associated with increased mortality; however, there was a linear trend toward increased mortality with increasing BF% and WHRadjBMI.

The researchers did not find a clear indication that increased obesity-PRSs were associated with reduced risk of CVD mortality among patients with known CVD. Sensitivity analyses by sex, age group and disease type, and by using a single variant from the FTO gene rs1558902 as an instrumental variable showed similar results.

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