Journal watch - review of the latest clinical papers 15/09/2021

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 the outcomes from a meta-analysis of long-term relapse rate of T2DM after RYGB, a study from the Cleveland Clinic that reported RYGB may be associated with greater weight loss, better diabetes control, and lower risk of MACE and nephropathy compared with SG, French researcher report that bariatric surgery increases an individual’s chance of finding a job independently of deprivation status, University of Minnesota researchers conclude that vertical sleeve gastrectomy may not increase the incidence of GERD compared to patients undergoing RYGB, finally, European researcher find that there is a huge variety of differences between European countries in terms of accessibility to and quality indicators of metabolic surgery (please note, log-in maybe required to access the full paper).

Meta-analysis of Long-Term Relapse Rate of Type 2 Diabetes Following Initial Remission After Roux-en-Y Gastric Bypass

Researchers from Lanzhou University Second Hospital, Lanzhou, Gansu, China, have reported that Roux-en-Y gastric bypass (RYGB) surgery may be a preferred procedure for patients with obesity and T2DM because it is associated with lower long-term relapse and relatively higher initial remission. Writing in Obesity surgery, they noted that RYGB was also superior to sleeve gastrectomy due to lower risk of recurrence.


For their meta-analysis, the study authors reviewed 17 eligible studies were included for analysis. The results revealed that a pooled long-term relapse rate of 0.30 (95% confidence interval [CI], 0.26–0.34) and a remission rate of 0.63 (95% CI, 0.55–0.72) after RYGB, and a hazard ratio of 0.73 (95% CI, 0.66–0.81) for comparison of RYGB and sleeve gastrectomy.


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Cardiovascular Outcomes in Patients With Type 2 Diabetes and Obesity: Comparison of Gastric Bypass, Sleeve Gastrectomy, and Usual Care

Writing in Diabetes Care, researchers primarily from the Cleveland Clinic, Cleveland, OH, sought to determine whether Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) is associated with greater reduction in risk of major adverse cardiovascular events (MACE) in patients with type 2 diabetes mellitus (T2DM) and obesity.


They compared 1,362 RYGB and 693 SG patients with 11,435 matched non-surgical patients with T2DM and obesity. With multivariable Cox regression analysis, they estimated time to incident extended MACE, defined as first occurrence of coronary artery events, cerebrovascular events, heart failure, nephropathy, atrial fibrillation, and all-cause mortality.


The cumulative incidence of the primary end point at five years was 13.7% in the RYGB group and 24.7% in the SG group. Of the six individual end points, RYGB was associated with a significantly lower cumulative incidence of nephropathy at five years compared with SG (2.8% vs. 8.3%,

p=0.005). However, RYGB patients required more upper endoscopy (45.8% vs. 35.6%, p<0.001) and abdominal surgical procedures (10.8% vs. 5.4%, p=0.001) vs with SG.


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Social isolation but not deprivation involved in employment status after bariatric surgery

Researchers from the Centre Hospitalier de Saint-Denis, Saint-Denis, France, have investigated the relationship between employment rate and weight loss, deprivation and Bariatric Analysis and Reporting Outcome System (BAROS) scores after bariatric surgery in a deprived area.


After surgery, 19 participants obtained a job, three were unemployed. Based on a multivariate analysis, employed and unemployed participants (77 vs 52) before surgery had a lower initial BMI and better BAROS and satisfaction scale scores. Obtaining a new job was not associated with BMI, sex or age differences.


They concluded that there was a positive correlation between social life score and weight loss, and bariatric surgery increased an individual’s chance of finding a job independently of deprivation status.


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Gastroesophageal Reflux Disease Outcomes After Vertical Sleeve Gastrectomy and Gastric Bypass

Researchers from the University of Minnesota, Minneapolis, MN, report in the Annals of Surgery, that vertical sleeve gastrectomy (VSG) may not increase the incidence of gastroesophageal reflux disease (GERD) compared to patients undergoing Roux-en-Y gastric bypass (RYGB).


A total, 8,362 VSG patients were matched 1:1 to patients undergoing RYGB, on the basis of post-operative follow-up interval. Among all patients, postoperative GERD was more frequently observed in VSG patients relative to RYGB patients (60.2% vs 55.6%; p<0.001), whereas Barrett oesophagus was more prevalent in RYGB patients (0.7% vs 1.1%; p=0.007). Postoperatively, de novo oesophageal reflux symptomatology was more common in VSG patients (39.3% vs 35.3%; p<0.001), although there was no difference in development of the histologic diagnoses reflux oesophagitis and Barrett oesophagus.


They concluded that these findings challenge the prevailing opinion that patients with GERD should undergo RYGB instead of VSG.


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First Inventory of Access and Quality of Metabolic Surgery Across Europe

There is a huge variety of differences between European countries in terms of accessibility to and quality indicators of metabolic surgery, according to European researchers. Writing in Obesity Surgery, they cite that a lack of funding, education and structure fuels these disparities.

From the 45 responses they report that:

  • 68% of countries had eligibility criteria for metabolic surgery;

  • 59% adhered to the guidelines

  • 46% had reimbursement criteria for metabolic surgery

  • 41% had eligibility criteria for plastic surgery and 31% reimbursement criteria

  • The average tariffs for a metabolic procedure varied €800 to €16,000

  • In 45%, metabolic surgery is performed by pure metabolic surgeons, whilst re-operations were performed by a metabolic surgeon in 28%

  • A metabolic training programme was available in 23%; and

  • Access to metabolic surgery was rated poor to very poor in 33%.

The authors called for the standardisation of criteria across Europe with clearer guidelines.

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