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Journal Watch 6/12/2023

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 a comparison of sleeve gastrectomy, gastric bypass and duodenal switch, association between bariatric hospitals and improved short-term outcomes after minimally invasive esophagectomy, 12 months outcomes of Orbera 365 intra-gastric balloons, beneficial and harmful effects from surgery, outcomes and rate of ICU admissions post-surgery, and anti-obesity medications impact on all-cause mortality in people with overweight or obesity and knee or hip osteoarthritis, and more (please note, log-in maybe required to access the full paper).

Comparative Multicenter Analysis of Sleeve Gastrectomy, Gastric Bypass and Duodenal Switch in Patients with BMI ≥ 70kg/m2: A Two-Year Follow-Up

A comparative multi-centre analysis of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB) and duodenal switch (DS) in patients with BMI ≥ 70kg/m2 has concluded that all the procedures had comparable safety profiles and complication rates, according to US researchers.

Writing in SOARD, the investigators noted that surgery with patients with a BMI≥70kg/m2 are considered a high-risk group, but there remains limited literature on the perioperative safety as well as the different procedural outcomes of bariatric surgery. As a result, they compared the safety profiles, early- and medium-term outcomes of of the three procedures in patients with BMI≥70kg/m2.

In total, 156 patients had surgery (SG=40, RYGB=40 and DS=76). Patient demographics and baseline characteristics were similar between all cohorts. Average baseline BMI was 75.5 kg/m2. Total weight loss (%TWL) at 24 months was highest in the DS group vs RYGB (40.6% vs. 33.8%, p=0.03) and SG (40.6% vs. 28.5%, p=0.006). There was no significant difference in %TWL between RYGB and SG (33.8% vs. 28.5%, p=0.20). The 30-day complication rates were similar [SG (7.5%), RYGB (10%), and DS (9.2%) (p=1.0)].

They noted that although DS achieved the highest %TWL at 24 months, similar comorbidity resolution rates among the procedures attenuate its clinical significance.

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The impact of hospital experience in bariatric surgery on short-term outcomes after minimally invasive esophagectomy: a nationwide analysis

There is an association between bariatric hospitals and improved short-term outcomes after minimally invasive esophagectomy (MIE), according to a nationwide analysis by investigators from The Netherlands.

Writing in Surgical Endoscopy, they study authors sought to investigate an association between hospital experience in bariatric surgery and short-term outcomes in MIE.

Gathering data from the Dutch Upper Gastrointestinal Cancer Audit, in total 3,371 patients undergoing esophagectomy in sixteen hospitals 2,450 (72.7%) underwent MIE. Bariatric hospitals (n=6) accounted for 1,057 (43.1%) MIE. The annual volume of bariatric procedures was median 523 and esophagectomies 42. In non-bariatric hospitals, volume of esophagectomies was median 52 (p=0.145). Overall postoperative complication rate was lower in bariatric hospitals (59.2% vs. 65.9%, P<0.001). Bariatric hospitals were associated with a reduced risk of overall complications, length of hospital and ICU stay after MIE.

The authors concluded that the characteristics of bariatric hospitals that could explain this phenomenon and whether this translates to other upper GI procedures may be warranted to identify.

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Safety and Efficacy of 12-Month Intra-gastric Balloon—Series of over 1100 Patients

The 12 months outcomes of Orbera 365 intra-gastric balloons (IGB, Apollo Endosurgery) have shown the device is safe with adverse events comparable to published literature, according to UK researchers.

Reporting in Obesity Surgery, 1149 patients were included in the study, a majority were female (87.13%) and the median body mass index (BMI) prior to insertion was 36.30kg/m2. Median absolute weight loss for all patients was 11.36kg. There was ongoing sustained weight loss until device removal at week 52.

For patients with a weight recording at point of IGB removal, median weight loss was greater (15.88 kg) with percentage total body weight loss of 15.38% and excess weight loss of 53.99%. Interestingly, the authors noted that increased patient engagement with post-procedural follow-up was associated with increased weight loss (p<0.001).

There were 60 total complications (5.22%) with fifty patients requiring balloon removal due to intolerance and there were eight cases of balloon rupture. There were only two severe complications (0.17%).

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Association of bariatric surgery with indicated and unintended outcomes: An umbrella review and meta-analysis for risk–benefit assessment

Bariatric surgery has both beneficial and harmful effects on a broader than expected array of patients' health outcomes, according to an umbrella review and meta-analysis for risk–benefit assessment by researchers from South Korea and Canada.

Writing in Obesity Reviews, the authors noted that bariatric surgery can cause numerous functional changes to patients, some of which are unintended. However, they stated that a systematic evaluation of wide-angled health benefits and risks following bariatric surgery has not been conducted.

As a result, they systematically evaluated published systematic reviews of randomised controlled trials and observational studies reporting the association between bariatric surgery and health outcomes. They also performed a subgroup analyses by surgery type and sensitivity analysis, excluding gastric band.

In total, 30 systematic reviews and 82 meta-analysed health outcomes were included. They found 66 (80%) health outcomes were significantly associated with bariatric surgery, of which ten were adverse outcomes, including suicide, fracture, gastroesophageal reflux after sleeve gastrectomy and neonatal morbidities. The other 56 outcomes were health benefits including new-onset diabetes mellitus (DM), hypertension, dyslipidaemia, cancers, cardiovascular diseases (CVDs) and women's health.

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Patient Outcomes and Rate of Intensive Care Unit Admissions Following Bariatric Surgery: A Retrospective Cohort Study of 775 Patients

Researchers from the King Hamad Univeristy Hospital, Muharraq, Bahrain, have reported much lower rate of intensive care unit (ICU) admissions after bariatric surgery compared to previous studies. According to the researchers, the findings highlight the need for comprehensive preoperative evaluations and individualised treatment plans to optimise the safety and success of bariatric surgery.

Writing in Cureus, the study authors retrospectively evaluated 775 patient outcomes and the rate of ICU admissions following bariatric surgery between 2018 and 2022.

In total, 775 patients included and most common primary procedure was laparoscopic sleeve gastrectomy (75%), followed by gastric bypass (22.6%). In revision bariatric surgery, the majority (91.3%) had a conversion from sleeve gastrectomy to gastric bypass.

Overall, 0.77% of patients were admitted to the ICU, with the majority being unplanned ICU admissions (0.52%). The average ICU stay was 21 days (1 to 54 days). The most common reason for ICU admission was sepsis, septic shock, and gastric leakage.

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Weight Loss Induced by Antiobesity Medications and All-Cause Mortality Among Patients With Knee or Hip Osteoarthritis

A slow-to-moderate, but not fast, rate of weight loss induced by anti-obesity medications (AOMs) is associated with a lower risk of all-cause mortality in people with overweight or obesity and knee or hip osteoarthritis (OA), according to an international team of researchers.

The authors write that current guidelines recommend weight loss for patients with overweight or obesity and knee or hip OA; however, there is a paucity of data on the relation of weight loss to death among patients with OA. Therefore, they sought to examine the relation of the rate of weight loss induced by AOMs over one year to all-cause mortality among patients with overweight or obesity and knee or hip OA.

They identified 6,524 people with overweight or obesity and knee or hip OA and found the five-year all-cause mortality rates were 5.3%, 4.0%, and 5.4% for weight gain or stable, slow-to-moderate weight loss, and fast weight loss arms, respectively. Compared with the weight gain or stable arm, hazard ratios of all-cause mortality were 0.72 for the slow-to-moderate weight loss arm and 0.99 for the fast weight loss arm.

Interestingly, they reported that dose–response protective effects of weight loss on incident hypertension, type 2 diabetes and venous thromboembolism but a slightly higher but not statistically significant risk of cardiovascular disease, in the fast rate of weight loss arm than in the weight gain or stable arm and no significant relations of weight loss to the risk of cancer.

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