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 from the latest American Gastroenterological Association guidance for early bariatric complications, the effectiveness of biliopancreatic and alimentary limb length, post-bariatric opioid use, intragastric balloons and more (please note, log-in maybe required to access the full paper).
AGA Clinical Practice Update on Evaluation and Management of Early Complications After Bariatric/Metabolic Surgery: Expert Review
The American Gastroenterological Association has published a clinical practice update on the
endoscopic evaluation and management of patients with early (<90 days) complications after undergoing bariatric/metabolic surgery. The guidance was published in the journal Clinical Gastroenterology and Hepatology.
The best practice advice stresses the importance of multidisciplinary approach and an understanding of the risks and benefits of alternative methods such as surgical and interventional radiological based approaches including concomitant fluoroscopy, stent deployment and retrieval, managing stenosis and managing percutaneous drains. The paper states that clinicians should recognise the goal for endoscopic management of staple-line leaks are often not necessarily initial closure of the leak site, but rather techniques to promote drainage of material from the perigastric collection into the gastric lumen such that the leak site closes by secondary intention.
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Effect of Roux-en-Y Gastric Bypass with Different Lengths of Biliopancreatic and Alimentary Limbs for Patients with Type 2 Diabetes Mellitus and a BMI < 35 kg/m2: 5-Year Outcomes in Chinese Patients
Published in Obesity Surgery, Chinese researchers have compared the effects of different biliopancreatic limb (BPL) and alimentary limb (AL) lengths on patient prognosis. They collected data from 87 patients with T2DM who underwent RYGB with a BPL of 50 cm and an AL of 50 cm (BPL50/AL50) or with a BPL of 100 cm and an AL of 100 cm (BPL100/AL100) and who were followed up for 5 years.
They reported that diabetes remission rate of the BPL100/AL100 group was significantly higher than that of the BPL50/AL50 group. Diabetes remission at 1 year after surgery correlated with the length limb (BPL + AL), duration of diabetes and TWL%. There was no difference in complications between BPL50/AL50 and BPL100/AL100.
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Opioid consumption in patients undergoing Roux-en-Y bariatric surgery compared with population controls with and without obesity
Writing in SOARD, investigators from Sweden report that RYGB surgery increased the risk of prolonged opioid use in patients with obesity who were non-users prior to surgery. In total, RYGB patients (n=23,898) were age- and sex-matched with one control patient with obesity (n=23,898) and two population controls without obesity (n=46,064).
They reported that within 24 months, 16.6% of RYGB patients started using opioids compared to 14.3% of controls with obesity (p<.0001) and 5.4% of population controls (p<.0001). They also found that opioid consumption in general was associated with chronic pain and psychiatric disorder, which were more common in patients with obesity than in the population controls.
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Six intragastric balloons: Which to choose?
Researchers from Greece and the UK, writing in the World Journal of Gastrointestinal Endoscopy, summarise the pros and cons of the six most commonly used intragastric balloons (IGBs):
Orbera
Spatz3
ReShape Duo
Elipse
Heliosphere
Obalon
The authors note that the advantages of IGBs are their easy application, reversibility and good short-term results. However, long-term results are not as good more invasive bariatric surgery and concerns about complications have also arisen. Here, the researchers analyse the characteristics and effectiveness and provide guidance in choosing the most appropriate balloon for each patient.
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The lived experience of patients with obesity: A systematic review and qualitative synthesis
Researchers from Ireland, writing in Obesity Reviews, report that there is lack of studies that focus solely on the experience of the patient and highlights the tendency for participant-informed, rather than participatory, methods in obesity research.
In their study, they systematically reviewed and synthesized peer-reviewed studies relating to the lived experience of patients with obesity including: the development of obesity; a life limited; stigma, judgment, shame and blame; treatment and; experiences of specific or minority groups.
They note that these patient perspective constructs reveal the factors associated with the development and maintenance of obesity; the impact of the stigma and judgment many patients are subjected to; and their experience of accessing, or trying to access, treatment for their healthcare needs. The paper calls for further participatory research into the experiences of people living with obesity.
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