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Journal Watch 6/3/2024

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 outcomes from the IFSO Worldwide Survey 2020–2021, five-year YOMEGA outcomes, routine upper gastrointestinal swallow study should be abandoned, surgery and diabetes feature highly in bibliometric analysis, the need for standardized BMS perioperative care,

and more (please note, log-in maybe required to access the full paper).

IFSO Worldwide Survey 2020–2021: Current Trends for Bariatric and Metabolic Procedures

The number of metabolic and bariatric surgery (MBS) procedures markedly decreased worldwide during 2020 and although there was a positive trend in 2021, it did not reach the values obtained before the COVID-19 pandemic, according to a survey by the Collaborative Study Group for the IFSO Worldwide Survey.

Published in Obesity Surgery, the survey aims to describe the current trends of MBS reporting on the number and types of surgical and endoluminal procedures performed in 2020 and 2021, in the world and within each IFSO chapter.

In total, 57 of the 74 (77%) IFSO national societies submitted the survey with 24 of the 57 (42.1%) reporting data from national registries. The total number of surgical and endoluminal procedures performed in 2020 was 507,806 and in 2021 was 598,834. Unsurprisingly, sleeve gastrectomy remained the most performed bariatric procedure.

Thirty national societies (52%) had regional protocols for MBS during COVID-19, 61.4% supported the use of telemedicine and only 47.3% collected data on mortality after MBS in 2020 (no significant change in 2021 (p>0.05).

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Efficacy and safety of one anastomosis gastric bypass versus Roux-en-Y gastric bypass at 5 years (YOMEGA): a prospective, open-label, non-inferiority, randomised extension study

French researchers have reported one anastomosis gastric bypass (OAGB) was not inferior to Roux-en-Y gastric bypass (RYGB) regarding percentage excess BMI loss at five years with similar metabolic outcomes. However, there was a higher rate of clinical gastro-oesophageal reflux disease after OAGB raising questions about the long-term consequences of OAGB, which need to be further investigated.

Writing in The Lancet Diabetes & Endocrinology, the YOMEGA trial recruited 253 patients who randomly assigned to OAGB (n=129) or RYGB (n=124), and from these patients 114 in the OAGB group and 118 in the RYGB group were included in the per-protocol analysis.

After five years, mean percentage excess BMI loss was –75·6% in the OAGB group vs –71·4% in the RYGB group, confirming non-inferiority (mean difference –4·1% [90% CI –12·0 to 3·7], p=0·0099).

Remission of type 2 diabetes was similar in both groups. Nutritional status did not differ; the most common adverse event was clinical gastro-oesophageal reflux disease, occurring in 27 (41%) of 66 patients in the OAGB group versus 14 (18%) of 76 patients in the RYGB group (p=0·0030). Among serious adverse events, ten (8%) of 127 patients converted from OAGB to RYGB.

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Does routine upper gastrointestinal swallow study after metabolic and bariatric surgery lead to earlier diagnosis of leak?

Routine upper gastrointestinal swallow study (SS) was not associated with earlier diagnosis of gastrointestinal leaks compared to the absence of routine SS after bariatric surgery, according to US researchers.

Writing in SOARD, they conducted an observational cohort study of adults who underwent laparoscopic primary RYGB (n=82,510) and sleeve gastrectomy (SG) (n=283,520) using the MBSAQIP 2015-2019 database. Propensity scores were used to match patient cohorts who underwent routine v. no routine SS.

In total, 36,280 (23%) RYGB and 135,335 (33%) SG patients received routine SS. Routine SS was not associated with earlier diagnosis of leak (RYGB routine SS median 7 [IQR 3-12] days v. no routine SS 6 [2-11] days, p=0.9; SG routine SS 15 [9-22] days v. no routine SS 14 [8-21] days, p=0.06) or lower risk of developing leak (RYGB HR 1.0, 95%-CI 0.8-1.2; SG HR 1.1, 95%-CI 1.0-1.4). More routine SS patients had a length of stay 2 days or greater (RYGB 78.3% v. 61.1%; SG 48.6% v. 40.3%).

They concluded that surgeons should consider abandoning the practice of routine SS for the purpose of obtaining earlier diagnosis of postoperative leaks.

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Research trends between diabetes mellitus and bariatric surgery researches: Bibliometric analysis and visualization from 1998 to 2023

There is a growing interest in the relationship between diabetes and bariatric surgery, according to bibliometric analysis by Chinese researchers.

Writing in Obesity Reviews, they explored the relationship between diabetes mellitus and bariatric surgery from January 1985 to August 2023. No publications were found between 1985 and 1998. However, from 1998 to 2023, a total of 9,496 English articles were identified, accumulating 291,289 citations (241,563 excluding self-citations) and achieving an H-Index of 197.

Leading contributors were from the US, China and Italy. Noteworthy authors in this area of research included Philip Schauer, Wei-Jei Lee and Carel W. le Roux, with the major journals that featured this research were Obesity Surgery, Diabetes Care, and Surgery for Obesity and Related Diseases. The most highly cited article focused on lifestyle, diabetes, and cardiovascular risks ten years after BS, emphasising the significant attention given to the nutritional, cardiac and general internal medicine impacts of diabetes and BS.

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The need for standardized perioperative care for patients undergoing bariatric and metabolic surgery in the United Kingdom

Researchers from Sunderland Royal Hospital, Sunderland, UK, have reported a significant variability of care throughout the bariatric and metabolic surgery (BMS) pathway.

Writing in Obesity Reviews, they carried out a survey to assess the level of consistency in patient care undergoing BMS. Bariatric nurse specialists from 30 bariatric units completed an anonymised, online survey from December 2022 to February 2023.

They reported most units (77%) have implemented a premade postoperative care bundle protocol including predetermined timing of oral intake (77%) and postoperative day 1 bloods (60%). Date of discharge is variable, ranging from 1 day after surgery (50%) to a ‘two night stay’ protocol (33%) to within 4 days after surgery (17%). Most follow-up clinics are either led by dietitians (33%) or both bariatric nurse specialists and dietitians collaboratively (57%). Patients are usually established on solid food six weeks after surgery in 53% (16/30) units. Chemical venous thromboembolism (VTE) prophylaxis was either given on day of surgery postoperatively (60%), day before (20%) or after (17%) surgery.

The results suggest a need for consensus guidelines outlining the best-practice approach to managing patients undergoing BMS due to the heterogeneity of the patient group, they concluded these guidelines should contain overarching generalisable recommendations that can then be tailored to individual patients.

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