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Journal watch - review of the latest clinical papers 29/09/2021

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 an examination of gastric sleeve stenosis following sleeve gastrectomy, calcium and vitamin D deficiencies after metabolic surgery, the impact of bariatric surgery on lipid profile, the affect of T2DM on steatosis in patients with obesity and the perioperative complications in patients with chronic kidney disease after RYGB and sleeve gastrectomy (please note, log-in maybe required to access the full paper).

Quantifying Healthcare Utilization and Delay in the Treatment of Gastric Stenosis Following Sleeve Gastrectomy

Writing in Obesity Surgery, researchers from the University of Michigan report that patients who develop gastric sleeve stenosis following sleeve gastrectomy experience significant delay in diagnosis and management.

Their retrospective review included 45 patients and the primary outcome was time between symptom development and treatment with pneumatic balloon dilation. Secondary outcomes included total healthcare utilisation in the number and charges of imaging and emergency room visits.

The found that the mean (± SD) time to treatment was 755 (± 713) days and the probability of receiving treatment at one, two and three years was 37%, 62%, and 76%, respectively. The average number of diagnostic non-therapeutic upper endoscopies was 1.6 ± 1.5 and the mean total charges were US$16,473 ± US$15,173.

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Preventing calcium and vitamin D deficiencies following weight loss and metabolic surgery

Higher parathyroid hormone (PTH) levels following RYBP, compared to SG, may imply patients who are inherently subjected to a greater degree of malabsorption and underlying nutritional deficiencies are undertreated, according to researchers from Australia.

In this retrospective analysis included 370 patients (SG, n=281 and RYGP, n=89), who underwent metabolic surgery at a single-centre group practice in Melbourne, Australia, over two years. They found that postoperative mean serum calcium levels and median serum vitamin D levels improved significantly by 24 months within both groups. However, serum PTH levels within the RYBP group were significantly higher than the SG group across all time points, but PTH levels following RYBP remained stable at 24 months. There was no significant improvement in PTH levels following RYBP among those with higher PTH levels preoperatively.

The authors, writing in BMC Surgery, state that these finding calls for a tailored supplementation protocol, particularly for those with high preoperative PTH levels undergoing RYBP, to prevent deficiencies.

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Correlation of Bariatric Surgery Effect on Lipid Profile Among Obese Patients

Sleeve gastrectomy significantly reduces triglyceride (TG) and elevates low high-density lipoprotein (HDL) in patients with morbid obesity, although elevated total cholesterol (TC) and low-density lipoprotein (LDL) are non-significantly affected, according to researchers from Taibah University, Madinah, Saudi Arabia.

Reporting in Cureus, they sought to assess the effect of sleeve gastrectomy on lipid profile of morbidly obese patients and they examined data from 163 patients. The researchers found that there was a significant change in the mean level of TG as it was significantly higher pre-operatively, compared to its mean level post-operatively.

They authors stated that additional studies with longer follow-up are needed to provide more reliable evidence.

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Type 2 diabetes mellitus increases the risk of hepatic fibrosis in individuals with obesity and nonalcoholic fatty liver disease

Researchers led by authors from the University of Florida, Gainesville, Florida, have reported that diabetes mellitus (DM) modestly impact steatosis, which was primarily driven by obesity. The findings were reported in the journal Obesity.

The study examined the impact of DM on both nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) with advanced fibrosis prevalence in adults with overweight or obesity in the US.

Using data from the National Health and Nutrition Examination Survey [NHANES] 2015-2016 database, they study included 834 patients with DM (21.7%) and 3,007 without DM (78.3%). They found that steatosis was higher in individuals with overweight with DM versus without DM (USFLI ≥ 30: 48.3% vs. 17.4%; p<0.01) and in individuals with obesity with DM versus without DM (USFLI ≥ 30: 79.9% vs. 57.6%; p<0.01).

Moreover, DM significantly increased the proportion of individuals at moderate-to-high risk of fibrosis (FIB-4 ≥ 1.67: 31.8% vs. 20.1%; p<0.05) and the risk in the advanced fibrosis group (FIB-4 ≥ 2.67) almost doubled (3.8% vs. 7.1%).

They concluded that DM added a significant risk of fibrosis to individuals with overweight or obesity, suggesting that screening is imperative in adults with DM.

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Perioperative Risks of Sleeve Gastrectomy Versus Roux-en-Y Gastric Bypass Among Patients With Chronic Kidney Disease - A Review of the MBSAQIP Database

Investigators from the University of Michigan have reported that patients with chronic kidney disease (CKD) experiences similar incidences of perioperative complications following RYGB and sleeve gastrectomy. They reported their findings in the Annals of Surgery.

Using data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, RYGB patients were 1:1 propensity-score matched with sleeve patients based on preoperative factors that influence operative choice. The primary outcomes were 30-day readmissions, surgical complications, medical complications and death.

There were 673 patients in both groups and there were no statistically significant differences in primary outcomes. For the secondary outcomes, acute kidney injury was statistically-significantly higher among RYGB patients (4.9% vs 2.7%, p=0.035).

They concluded that the perception that RYGB has prohibitively-high perioperative risks among CKD patients is disputable and operative selection should be weighed on patient candidacy and anticipated long-term benefit.

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