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Journal watch - review of the latest clinical papers 27/10/2021

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 an assessment of US insurance coverage of paediatric bariatric patients, conversion to RYGB after OAGB, predicting remission of diabetes following bariatric surgery, a French study looking at malignancy in bariatric surgery patients, and lean body mass post-surgery (please note, log-in maybe required to access the full paper).

Insurance Coverage of Pediatric Bariatric Surgery: a Cross-Sectional Analysis of the USA

Researchers from the University of Maryland Medical Center examined the insurance coverage criteria for adolescents relative to adults and they surveyed medical policies of the 50 highest market share health insurance providers in the USA and compared them to the American Society for Metabolic and Bariatric Surgery (ASMBS) guidelines.

Writing in Obesity Surgery, they report that 66% (n=33) of companies provided inclusion criteria for adolescents and all covered RYGB (n=33), most covered sleeve gastrectomy (n=32, 97.0%). Obstructive sleep apnea (OSA) (n=32, 97%), hypertension (HTN) (n=27, 81.8%), and gastroesophageal reflux disease (GERD) (n= 11, 33.3%) were the three most commonly cited co-morbidities used as inclusion criteria. Twenty (60.6%) insurers required medical weight management programmes.

The study authors concluded that contrary to ASMBS guidelines, companies commonly require Tanner staging and/or skeletal maturity criteria as well as participation in medical weight management programmes.

To access this paper, please click here

Also in Obesity Surgery this week, Abstracts of the 12th BOMSS Annual Scientific Meeting Obesity Surgery (2021). To access the abstracts, please click here

Conversion from One Anastomosis Gastric Bypass to Roux-en-Y Gastric Bypass: When and why – A single center experience of all consecutive OAGB procedures

University of Vienna investigators have sought to determine the reasons for conversion, preoperative endoscopic findings and feasibility of revisional bariatric surgery after one anastomosis gastric bypass (OAGB) to Roux-en-Y Gastric bypass (RYGB).

In total, 82 of 1025 patients who had OAGB were converted laparoscopically to RYGB. Median time to late conversion was 29.1±24.3 months, mean %EWL 86.6±33.1%, %TWL 35.1±13. Forty-two patients were converted due to reflux, 11 due to persistent marginal ulcers, 10 due to anastomotic stenosis, 9 due to malnutrition and 3 due to weight regain. Seven patients showed Barrett’s metaplasia in biopsies at the gastroesophageal junction before conversion.

The authors report in SOARD, that severe (bile) reflux is a serious long-term complication after OAGB with 4.1% of patients needing conversion to RYGB, which is technically feasible with a moderate rate of postoperative complications. They strongly advised that endoscopy after OAGB in patients showing clinical symptoms of GERD to detect underlying pathological changes.

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Prognostic Models for Predicting Remission of Diabetes Following Bariatric Surgery: A Systematic Review and Meta-analysis

Writing in Diabetes Care, authors from the University of Birmingham carried out a systematic review of currently available diabetes remission prediction models, compared their performance, and evaluated their applicability in clinical settings.

In total, they identified 38 papers - 16 model development and 22 validation studies – and of the 16 model development studies, 11 developed scoring systems and five proposed logistic regression models. Two prediction models, ABCD and DiaRem, were widely externally validated in different populations, in a variety of bariatric procedures, and for both short- and long-term diabetes remission.

While the key messages were consistent, a large proportion of the studies were conducted in small cohorts of patients with short duration of follow-up.

ABCD and DiaRem models were the most widely validated and showed acceptable to excellent discrimination, however, the authors stated more studies validating newer models and focusing on long-term diabetes remission are needed.

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Malignancy in bariatric surgery patients: a French multisite cohort

French investigators, reporting in Surgical Endoscopy, have concluded that a history of malignancy should not be considered as an absolute contraindication for bariatric surgery.

They conducted a retrospective cohort study of all patients who underwent bariatric surgery in six university centres, and the patients were divided in two groups: patients with a preoperative history of malignancy and patients diagnosed with malignancy during the follow-up. In addition, both groups were compared with control groups of patients that underwent surgery during the same period.

Of 8,927 patients who underwent bariatric surgery. 90 had a history of malignancy, with breast and gynaecologic cancers the most predominant (37.8%). Median interval between malignancy and surgery was 60 (38–118) months. After a follow-up of 24 (4–52) months, four patients presented with cancer recurrence. In patients with postoperative malignancy (n=32), breast and gynaecologic cancers were also predominant (40.6%).

The concluded that gynaecological cancer screening should be reinforced before and after surgery. The development of malignancy postoperatively does not seem to affect mid-term bariatric outcomes.

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The magnitude and progress of lean body mass, fat-free mass, and skeletal muscle mass loss following bariatric surgery: A systematic review and meta-analysis

Researchers from The Netherlands, writing in Scientific Reports, have found that lean body mass (LBM), fat-free mass (FFM) and skeletal muscle mass (SMM) were predominantly lost within three-months post-surgery, highlighting interventions to mitigate such losses should be implemented perioperatively.

The systematic review included studies that assessed LBM (n=37), FFM (n=20) or SMM (n=3) preoperatively and ≥1 time points post-surgery. Random-effects meta-analyses were performed to determine pooled loss per outcome parameter and follow-up time point. At 12-month postsurgery, pooled LBM loss was −8.13kg, FFM loss was −8.23kg and SMM loss was −3.18kg.

They noted that approximately 55% of 12-month LBM loss occurred within three-months post-surgery, followed by a more gradual decrease up to 12 months. Similar patterns were seen for FFM and SMM.

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