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 an updated position statement from the ASMBS on VTE and bariatric surgery, a Clinical Practice Update from the AGA on the endoscopic management of GI perforations, short-term mortality and long-term mortality is higher in men compared to women after bariatric surgery, defining T2DM remission and a study highlighting that patients with morbid obesity undergoing general surgery may benefit from having general surgery at a high volume bariatric centres (please note, log-in maybe required to access the full paper).
The American Society for Metabolic and Bariatric Surgery (ASMBS) Updated Position Statement on Perioperative Venous Thromboembolism Prophylaxis in Bariatric Surgery
The American Society for Metabolic and Bariatric Surgery’s Clinical Issues Committee has issued a second update on prophylactic measures for reducing the risk of venous thromboembolism (VTE) in bariatric surgery patients, after the previous update in 2013. The statement, published in SOARD, enhances the quality of care in bariatric surgery by reviewing the available evidence on VTE prophylaxis.
However, the authors note that since there is limited high-quality data, these practice guidelines suggest some recommendations that are based on available knowledge, peer-reviewed scientific literature, and expert opinion regarding reasonable use of prophylactic measures for VTE in bariatric surgery patients.
The statement will be revised in the future when additional evidence becomes available.
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AGA Clinical Practice Update on Endoscopic Management of Perforations in Gastrointestinal Tract: Expert Review
The AGA Institute Clinical Practice Updates Committee and the AGA Governing Board has published guidance on the endoscopic management of perforations in gastrointestinal tract. The update, published in Clinical Gastroenterology and Hepatology, describes the current methodologies available on steps to prevent, detect subtle signs of, and endoscopically manage gastrointestinal perforations.
The paper, which includes 16 ‘Best Practice Advice’, notes that one of the most devastating complications in any endoscopic procedure is a perforation that can result in a life-threatening situation for the patient and abrupt termination of the intended procedure.
The paper includes recommendations on through-the-scope clips (TTSCs), over-the-scope clips (OTSCs), self-expanding metal stents (SEMS), endoscopic suturing, and some novel approaches (biological glue, oesophageal vacuum therapy) in the management of luminal perforations.
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Sex-Specific Differences in Mortality of Patients with a History of Bariatric Surgery: a Nation-Wide Population-Based Study
Researchers led by the Medical University of Vienna have reported that short-term mortality and long-term mortality is higher in men compared to women, after bariatric surgery.
Writing in Obesity Surgery, the authors performed an analysis of sex-specific differences after bariatric surgery in a population-based dataset from Austria. They found that overall mortality rate was 0.34% per year of observation and significantly higher in men compared to women (0.64 vs. 0.24%; p<0.001). Moreover, the 30-day mortality was 0.19% and sixfold higher in men vs. women (0.48 vs. 0.08%; p<0.001). Diabetes (38%) was more common in men (43 vs. 33%; p=0.034), whereas malignant diseases (36%) were more frequent in women (30 vs. 41%; p=0.025).
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Defining type 2 diabetes remission: KISS goodbye to confusion?
Writing in The Lancet Diabetes & Endocrinology, Professor Shahrad Taheri, Director of the Clinical Research Core at Weill Cornell Medicine, Qatar, examines the evidence that type 2 diabetes can revert to glycaemic levels below the diabetes threshold without diabetes medications (type 2 diabetes remission).
In this paper, he looks at differing weight loss strategies including metabolic surgery and evidence from randomised clinical trials that have demonstrated weight loss, reduced liver & pancreatic fat, and carbohydrate restriction, all of which can result in type 2 diabetes remission.
Factors such as younger age, early-stage disease, lower number of diabetes medications and greater weight loss are indicators for type 2 diabetes remission, for both surgical and non-surgical interventions.
Taheri notes that the greatest challenge to sustaining type 2 diabetes remission is maintenance of weight loss and lifestyle change.
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The Effect of Bariatric Surgery Volume on General Surgery Outcomes for Morbidly Obese Patients
Patients with morbid obesity undergoing general surgery may benefit from having general surgery at a high volume bariatric centres, according to researchers from the Medical College of Wisconsin.
The authors believe that the benefits come from the familiarity with the management principles required to minimise the postoperative risk associated with morbid obesity and improve patient outcomes. The findings were was published in the Journal of Obesity.
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