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Saberdoust F, Salehabadi G, Sheykholeslamy S, Noroozi E, Moradi M, Pazouki A, Kabir A. Diagnostic Value of Advanced-DiaRem for Predicting Diabetic remission after One Anastomosis Gastric Bypass/Minigastric Bypass. Obes Surg 2024; 34:3467-3474. [PMID: 39080227 DOI: 10.1007/s11695-024-07431-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 07/20/2024] [Accepted: 07/23/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND Obesity is a main risk factor for type 2 diabetes. Bariatric surgery can help diabetic patients with obesity. Among different types of metabolic surgeries, one anastomosis gastric bypass (OAGB) surgery is a new procedure. AIM To comprehensively determine the diagnostic values of advanced-diabetic remission (Ad-DiaRem), one of the scoring systems, in predicting diabetic remission after OAGB surgery. METHODS In this retrospective cohort study, patients aged 18-60 years with type 2 diabetes and obesity, who had undergone OAGB surgery, were included. Diagnostic values of Ad-DiaRem on diabetes remission, after OAGB surgery, which consist of sensitivity (Sen), specificity (Spe), positive and negative predictive values (P/NPV), positive and negative likelihood ratios (P/NLR), accuracy, and odd ratio (OR), were determined. RESULTS The percentages of complete diabetic remission after surgery were 56.3% and 53.8% in 12th and 24th months, respectively. The remission cut-off point for Ad-DiaRem was defined 10 considering the highest Youden's index. Among the evaluation indices, the values of Spe, PPV, accuracy, and OR were assigned a high value in both 12th and 24th months of follow-up; however, the area under curve (AUC) was 20% in both. CONCLUSION According to our findings, the model of diagnostic values of Ad-DiaRem for predicting diabetic remission should be specified according to race, place of residence, and prevalence of diabetes in society. Presently, this model can be used cautiously until a new model is proposed by further studies.
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Affiliation(s)
- Fateme Saberdoust
- Department of Surgery, Iran University of Medical Sciences (IUMS), Shahid Hemmat Highway, Tehran, 14496-14535, Iran
| | - Ghazaleh Salehabadi
- Department of Radiology, Iran University of Medical Sciences (IUMS), Shahid Hemmat Highway, Tehran, 14496-14535, Iran
| | - Shakiba Sheykholeslamy
- School of Medicine, Iran University of Medical Sciences (IUMS), Shahid Hemmat Highway, Tehran, 14496-14535, Iran
| | - Elahe Noroozi
- Oncopathology Research Center, Iran University of Medical Sciences (IUMS), Shahid Hemmat Highway, Tehran, 14496-14535, Iran
| | - Marziyeh Moradi
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences (IUMS), Shahid Hemmat Highway, Tehran, 14496-14535, Iran
| | - Abdolreza Pazouki
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences (IUMS), Shahid Hemmat Highway, Tehran, 14496-14535, Iran
- Center of Excellence of European Branch of International Federation for Surgery of Obesity, Tehran, Iran
| | - Ali Kabir
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences (IUMS), Shahid Hemmat Highway, Tehran, 14496-14535, Iran.
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Pan HM, Lee WJ, Ser KH, Soong TC, Lee MH, Lin CH, Hsu KF. Impact of metabolic bariatric surgery on outcomes and the 10-year risk of major adverse cardiovascular events during a 7-year period: a retrospective cohort study. Int J Surg 2024; 110:5563-5573. [PMID: 38770830 PMCID: PMC11392150 DOI: 10.1097/js9.0000000000001631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/07/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Metabolic bariatric surgery offers enduring weight reduction and alleviation of obesity-related comorbidities, including dyslipidemia, diabetes, hypertension, and major adverse cardiovascular events (MACE). Long-term data on one-anastomosis gastric bypass (OAGB) and single-anastomosis duodenal-jejunal bypass with sleeve gastrectomy (SADJB-SG) is lacking, necessitating this investigation. MATERIALS AND METHODS In this multicenter prospectively-collected retrospective observational study, 830 adult Taiwanese patients (682 OAGB, 148 SADJB-SG) who underwent surgery from 1 January 2011 to 31 December 2017, were initially identified. Following protocol, 224 patients (177 OAGB, 47 SADJB-SG) with complete follow-up data at various intervals up to 3 years after surgery were included in the final analysis. The study's primary focus is to evaluate the long-term safety, efficacy, and durability of OAGB and SADJB-SG in promoting weight loss and diabetes remission. Additionally, changes in 10-year and lifetime risks of MACE before and 3-year after surgery are assessed using Taiwan MACE risk prediction model and the China-PAR project model. RESULTS SADJB-SG patients exhibit higher diabetes prevalence, lower BMI, and more severe diabetes compared to OAGB. Both groups demonstrate significant improvements in BMI, diabetes, hypertension, and dyslipidemia three years after surgery, with the most substantial improvements occurring in the second year. The Taiwan MACE risk model reveals a significant reduction in 10-year MACE and stroke risks for both groups. The China-PAR project model indicates a synchronized reduction in atherosclerotic cardiovascular disease 10-year and lifetime risk in both OAGB and SADJB-SG groups. CONCLUSIONS OAGB and SADJB-SG exhibit sustained improvements in weight reduction and obesity-related comorbidities over 3 years after surgery. Notably, both procedures contribute to a substantial reduction in 10-year MACE, stroke, and atherosclerotic cardiovascular disease risks. These findings underscore the efficacy of OAGB and SADJB-SG in the context of metabolic bariatric surgery.
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Affiliation(s)
- Hsin-Mei Pan
- Division of General Surgery, Department of Surgery/Bariatric and Metabolic Surgery and Weight Management Center, Tri‑Service General Hospital, National Defense Medical Center, Taipei
| | - Wei-Jei Lee
- Medical Weight Loss Center, China Medical University Hsinchu Hospital, Hsinchu
| | - Kong-Han Ser
- Bariatric and Metabolic Surgery Center, Ten-Chan General Hospital, Taoyuan
| | - Tien-Chou Soong
- Center for Weight Loss and Health Management, E-DA Dachang Hospital/College of Medicine, I-Shou University
| | - Ming-Hsien Lee
- Metabolic and Bariatric Surgical Department, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation/Department of Surgery, School of Medicine, Tzu Chi University, Hualien
| | - Chien-Hua Lin
- Division of General Surgery, Department of Surgery/Bariatric and Metabolic Surgery and Weight Management Center, Tri‑Service General Hospital, National Defense Medical Center, Taipei
- Department of Surgery, IRCAD Taiwan, Chang-Bing Show Chwan Memorial Hospital, Taiwan
| | - Kuo-Feng Hsu
- Division of General Surgery, Department of Surgery/Bariatric and Metabolic Surgery and Weight Management Center, Tri‑Service General Hospital, National Defense Medical Center, Taipei
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Jain M, Tantia O, Goyal G, Chaudhuri T, Khanna S, Majumdar K, Gupta S. LSG vs OAGB: 7-Year Follow-up Data of a Randomised Control Trial and Comparative Outcome Based on BAROS Score. Obes Surg 2024; 34:1295-1305. [PMID: 38427149 DOI: 10.1007/s11695-024-07114-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 02/08/2024] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND This study aims to evaluate and compare long-term results of laparoscopic sleeve gastrectomy (LSG) and one anastomosis gastric bypass (OAGB) based on bariatric analysis reporting and outcome system (BAROS) score. MATERIALS AND METHODS Patients operated for morbid obesity between 2013 and 2015 were randomised to LSG and OAGB groups. Based on inclusion and exclusion criteria, 201 patients (100 LSG and 101 OAGB) were analysed for changes in total body weight (TBW), body mass index (BMI), percent excess weight loss (%EWL), percent total weight loss (%TWL), QoL (quality of life) scores, comorbidity resolution and outcome based on BAROS at 7 years. RESULTS Sixty-six LSG and 64 OAGB patients were followed up at 7 years. Mean pre-operative TBW and BMI were 119 ± 28.2 and 44.87 ± 7.71 for LSG group and 113.25 ± 23.74 and 44.71 ± 8.75 for OAGB group respectively. At 7 years after surgery, there was significant drop in mean TBW and BMI in both groups. Mean %EWL for LSG and OAGB patients was 50.78 ± 28.48 and 59.99 ± 23.32 and mean %TWL for LSG and OAGB patients was 23.22 ± 12.66 and 27.71 ± 12.27 respectively. Mean QoL scores at 7 years were significantly higher than the pre-operative scores and most of the patients in both groups had remission or improvement in their comorbidities. 68.76% OAGB patients had very good or excellent outcome on BAROS score while only 36.37% LSG patients had similar outcome. CONCLUSIONS LSG and OAGB are successful bariatric procedures over the long term. OAGB outperforms LSG and has significantly higher %EWL and %TWL over the long term.
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Affiliation(s)
- Mayank Jain
- Department of Minimal Access & Bariatric Surgery, Synergyplus Hospital, NH2, Near Guru Ka Taal, Agra, 282007, Uttar Pradesh, India
| | - Om Tantia
- Department of Minimal Access & Bariatric Surgery, ILS Hospitals, DD-6, Sector 1, Salt Lake City, Kolkata, 700064, West Bengal, India.
| | - Ghanshyam Goyal
- Department of Minimal Access & Bariatric Surgery, ILS Hospitals, DD-6, Sector 1, Salt Lake City, Kolkata, 700064, West Bengal, India
| | - Tamonas Chaudhuri
- Department of Minimal Access & Bariatric Surgery, ILS Hospitals, DD-6, Sector 1, Salt Lake City, Kolkata, 700064, West Bengal, India
| | - Shashi Khanna
- Department of Minimal Access & Bariatric Surgery, ILS Hospitals, DD-6, Sector 1, Salt Lake City, Kolkata, 700064, West Bengal, India
| | - Kajari Majumdar
- Department of Minimal Access & Bariatric Surgery, ILS Hospitals, DD-6, Sector 1, Salt Lake City, Kolkata, 700064, West Bengal, India
| | - Sonam Gupta
- Department of Minimal Access & Bariatric Surgery, ILS Hospitals, DD-6, Sector 1, Salt Lake City, Kolkata, 700064, West Bengal, India
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Hu L, Wang L, Li S, Liu Y, Zhang Z, Xiao M, Zhang Z, Wei Z, Cui L, Jiang T. Evaluation study of single-anastomosis duodenal-ileal bypass with sleeve gastrectomy in the treatment of Chinese obese patients based on efficacy and nutrition. Sci Rep 2024; 14:6522. [PMID: 38499796 PMCID: PMC10948890 DOI: 10.1038/s41598-024-57289-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/16/2024] [Indexed: 03/20/2024] Open
Abstract
To evaluate the efficacy and nutrition of single-anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) in Chinese obese patients in the first postoperative year. Clinical data of 66 obese patients who underwent SADI-S surgery at China-Japan Union Hospital of Jilin University from November 2018 to May 2022 were retrospectively collected. The weight, body mass index (BMI), percentage of excess weight loss (%EWL), and percentage of total weight loss (%TWL) were recorded at 3, 6, and 12 months after surgery. Moreover, metabolic disease remission and nutrient deficiencies were assessed at 1 year postoperatively. Overall, 66 patients (38 males and 28 females) were recruited, with a mean age of 35 (18-61) years and an average preoperative BMI of 42.94 kg/m2. Before surgery, 38 patients had type 2 diabetes mellitus (T2DM), 46 patients had hyperuricemia (HUA), 45 patients had hypertension (HTN), 35 patients had hyperlipidemia, 12 patients had hypercholesterolemia, 12 patients had hyper-low-density lipoproteinemia, and 14 patients had gastroesophageal reflux disease symptoms (GERD). All patients had undergone a DaVinci robotic or laparoscopic SADI-S surgery, and none converted to laparotomy or died. Four patients developed postoperative complications and were cured and discharged after conservative treatment or surgical treatment. At 3, 6 and 12 months, the average %EWL was 62.07 ± 26.56, 85.93 ± 27.92, and 106.65 ± 29.65%, %TWL was 22.67 ± 4.94, 32.10 ± 5.18, and 40.56 ± 7.89%, respectively. Fasting blood glucose (FBG), glycated hemoglobin (HbA1c), uric acid (UA), triglycerides (TG), blood pressure (BP), and other indexes were significantly lower after one year post-surgery compared with the preoperative period (P < 0.05). The remission rates of T2DM, HUA, HTN, hypertriglyceridemia, hypercholesterolemia, and hyper-low-density lipoproteinemia 1 year after surgery were 100, 65.2, 62.2, 94.3, 100, and100%, respectively. One year after surgery, the remission rate of GERD was 71.4% (10/14), the rate of new occurrence of GERD was 12.1% (8/66), and the overall incidence rate was 18.2% (12/66). Except for vitamin B12(vit B12), the other nutrient indexes were significantly decreased after 1 year of surgery relative to levels before surgery (P < 0.05). The deficiency rates for vitamin A (vit A), vitamin E (vit E), zinc ion (Zn), and folic acid (FA) were higher (45.5, 25.8, 24.2, and 16.7%, respectively); however, there were no related clinical symptoms. SADI-S had significant effects on weight loss and metabolic disease remission. The main nutrient deficiencies after SADI-S were vit A, vit E, Zn, and FA deficiencies. The long-term efficacy and safety of SADI-S warrant further follow-up.
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Affiliation(s)
- Lifu Hu
- Department of Bariatric and Metabolic Surgery, China-Japan Union Hospital, Jilin University, Changchun, 130033, China
| | - Lun Wang
- Department of Bariatric and Metabolic Surgery, China-Japan Union Hospital, Jilin University, Changchun, 130033, China
| | - Shixing Li
- Department of Bariatric and Metabolic Surgery, China-Japan Union Hospital, Jilin University, Changchun, 130033, China
| | - Yang Liu
- Department of Bariatric and Metabolic Surgery, China-Japan Union Hospital, Jilin University, Changchun, 130033, China
| | - Zheng Zhang
- Department of Bariatric and Metabolic Surgery, China-Japan Union Hospital, Jilin University, Changchun, 130033, China
| | - Minghao Xiao
- Department of Bariatric and Metabolic Surgery, China-Japan Union Hospital, Jilin University, Changchun, 130033, China
| | - Zhenhua Zhang
- Department of Bariatric and Metabolic Surgery, China-Japan Union Hospital, Jilin University, Changchun, 130033, China
| | - Zhiqiang Wei
- Department of Bariatric and Metabolic Surgery, China-Japan Union Hospital, Jilin University, Changchun, 130033, China
| | - Liang Cui
- Department of Bariatric and Metabolic Surgery, China-Japan Union Hospital, Jilin University, Changchun, 130033, China
| | - Tao Jiang
- Department of Bariatric and Metabolic Surgery, China-Japan Union Hospital, Jilin University, Changchun, 130033, China.
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Efficacy and safety of single-anastomosis duodenal-ileal bypass with sleeve gastrectomy for the treatment of Chinese T2D patients with obesity. Asian J Surg 2023; 46:756-760. [PMID: 35817706 DOI: 10.1016/j.asjsur.2022.06.152] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/23/2022] [Accepted: 06/30/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Bariatric surgery is the most effective treatment for obese T2D. As one of the most effective bariatric surgeries, SADI-S was recently introduced in China, and there is limited evidence of its efficacy and safety in the treatment of obese T2D. The aim of this study is to investigate the safety and efficacy of SADI-S in the treatment of obese T2D in China. METHODS The clinical data of 32 obese T2D patients who underwent SADI-S was included in this study. Changes in weight-related indicators, diabetes-related indicators, and patient nutritional outcomes were analyzed. RESULTS SADI-S was conducted successfully in all of the 32 cases without conversion to laparotomy or death. The incidence of surgical complications was 15.6% (5/32). The major complication rate was 6.3% (2/32). At 1 year after surgery, the BMI (kg/m2) significantly decreased from 40.8 ± 7.4 to 23.9 ± 2.9 (P < 0.05) and the mean HbA1c significantly decreased from 8.5% (6.4-11.5) to 5.0% (3.8-5.6) (P < 0.05). At 2 years after surgery, the BMI (kg/m2) significantly decreased to 24.9 ± 2.4 (P < 0.05) and the mean HbA1c significantly decreased to (4.8 ± 0.4)% (P < 0.05). The %TWL was (40.4 ± 6.5)% and (42.9 ± 4.9)% at 1 year and 2 years, respectively. The complete remission rates for T2D were both 100% at 1 year and 2 years. Triglyceride levels were significantly improved compared with preoperative, from (3.2 ± 3.0) mmol/L to (1.0 ± 0.3) mmol/L (P < 0.05), but there was no significant difference in other nutritional outcomes. CONCLUSION The SADI-S has excellent curative effect in the treatment of Chinese obese T2D, but the operation is challenging and the complication rate is high. Its long-term efficacy and safety require further study.
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Comparing Patient Selection and 30-day Outcomes Between Single Anastomosis Gastric Bypass and Roux-en-Y Gastric Bypass: a Retrospective Cohort Study of 47,384 Patients. Obes Surg 2023; 33:188-194. [PMID: 36322343 PMCID: PMC9628415 DOI: 10.1007/s11695-022-06353-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/20/2022] [Accepted: 10/25/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Single anastomosis gastric bypass (SAGB) offers a novel bariatric procedure with increasing popularity. However, its adoption, patient selection, and short-term safety remain poorly characterized. MATERIALS AND METHODS The 2020 Metabolic and Bariatric Accreditation and Quality Improvement Program (MBSAQIP) was analyzed comparing SAGB to Roux-en-Y gastric bypass (RYGB). Bivariate analysis and multivariable logistic regression models compared difference between groups and factors associated with 30-day serious complications and mortality. RESULTS Overall, 47,384 patients were evaluated, with 1344 (2.8%) undergoing SAGB. SAGB patients had a higher BMI (45.2 ± 7.6 kg/m2 vs 44.6 ± 7.9 kg/m2, p = 0.006) and younger age (44.3 ± 12.1 years vs. 45.4 ± 11.5 years, p = 0.0008) than RYGB patients respectively. SAGB patients were less likely to have GERD (42.6% SAGB vs. 45.7% RYGB, p = 0.02), sleep apnea (37.8% SAGB vs. 41.1% RYGB, p = 0.02), and chronic steroid use (1.3% SAGB vs. 2.2% RYGB, p = 0.04). There were no significant difference in diabetes, hypertension, or dyslipidemia rates. Operative length for SAGB was significantly less than for RYGB (101 ± 53.7 min SAGB vs. 131.5 ± 63.3 min RYGB, p < 0.0001). SAGB was independently associated with decreased serious complications (4.7% vs. 8.4%, p < 0.0001) within 30 days compared to RYGB. Additionally, SAGB patients were less likely to experience reoperation (1.6% vs. 2.6%, p = 0.03), and readmission (2.2 vs. 5.8%, p < 0.0001) compared to RYGB respectively. CONCLUSIONS Compared to RYGB, patients undergoing SAGB were younger with marginally higher BMI. After adjusting for comorbidities, SAGB was associated with decreased odds of serious complications. Ongoing prospective studies analyzing long-term outcomes following SAGB remain needed.
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Bariatric surgery trends and progress in Taiwan: 2010-2021. Obes Res Clin Pract 2023; 17:66-73. [PMID: 36623996 DOI: 10.1016/j.orcp.2022.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/04/2022] [Accepted: 12/18/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Taiwan is a leading country regarding bariatric surgery in Asia-Pacific. Since 2010, the Taiwan Society for Metabolic and Bariatric Surgery (TSMBS) has been accountable for the national evolution of bariatric surgery and inaugurated a national database accordingly. This study aimed to analyze the bariatric surgery trends and progress in Taiwan from 2010 to 2021. MATERIALS AND METHODS The TSMBS database was collected on the basis of structured inquiries filled out by bariatric surgeons in Taiwan. All patients involving bariatric surgery were included. The data were stratified with the following objectives, including the types of bariatric procedures, demographic characteristics, and perioperative variables. A nationwide database was comprehensively analyzed and evaluated to determine the trends in the applications of the procedure. RESULTS Data of 30,026 patients were enrolled. A 2.5-fold increase was observed in bariatric procedures, from 1218 in 2010 to 3005 in 2021. Within 12 years, female accounts for 61.8 %. The revisional rate was 3.40 % during the exploration stage (2010-2013), 2.77 % during the maturity stage (2013-2018), and 5.10 % during the expansion stage (2019-2021). The top five of primary bariatric surgery is sleeve gastrectomy (SG, 63.05 %), gastric clipping surgery (GC, 11.17 %), Roux-en-Y gastric bypass (RYGB, 9.34 %), one anastomosis gastric bypass (OAGB, 8.80 %), and sleeve plus surgery (SG plus, 4.43 %). CONCLUSION The trends and progress of Taiwan's bariatric surgery within recent decades are presented in this article. Taiwan's bariatric surgery case number has increased steadily from 2010 to 2021. Amongst all, SG has become the most dominant procedure since 2011 while OAGB takes up second place in 2020.
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Li M, Liu Y, Lee WJ, Shikora SA, Robert M, Wang W, Wong SKH, Kong Y, Tong DKH, Tan CH, Zeng N, Zhu S, Wang C, Zhang P, Gu Y, Bai R, Meng F, Mao Z, Zhao X, Wu L, Liu Y, Zhang S, Zhang P, Zhang Z. Efficacy and safety of one anastomosis gastric bypass versus Roux-en-Y gastric bypass for type 2 diabetes remission (ORDER): protocol of a multicentre, randomised controlled, open-label, superiority trial. BMJ Open 2022; 12:e062206. [PMID: 36175102 PMCID: PMC9528602 DOI: 10.1136/bmjopen-2022-062206] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Previous studies have demonstrated that one anastomosis gastric bypass (OAGB) is not inferior to Roux-en-Y gastric bypass (RYGB) in treating obesity. However, high level evidence comparing the efficacy and safety of both procedures in type 2 diabetes (T2D) treatment is still lacking, which is another main aim of bariatric surgery. The presented trial has been designed to aim at investigating the superiority of OAGB over the reference procedure RYGB in treating T2D as primary endpoint. And diabetes-related microvascular and macrovascular complications, cardiovascular comorbidities, weight loss, postoperative nutritional status, quality of life and overall complications will be followed up for 5 years as secondary endpoints. METHODS AND ANALYSIS This prospective, multicentre, randomised superiority open-label trial will be conducted in patients of Asian descent. A total of 248 patients (BMI≥27.5 kg/m2) who are diagnosed with T2D will be randomly assigned (1:1) to OAGB or RYGB with blocks of four. The primary endpoint is the complete diabetes remission rate defined as HbA1c≤6.0% and fasting plasma glucose≤5.6 mmol/L without any antidiabetic medications at 1 year after surgery. All secondary endpoints will be measured at different follow-up visit points, which will start at least 3 months after enrolment, with a continuous annual follow-up for five postoperative years in order to provide solid evidence on the efficacy and safety of OAGB in patients with T2D. ETHICS AND DISSEMINATION The study has been approved by the ethics committee of leading centre (Beijing Friendship Hospital, Capital Medical University, no. 2021-P2-037-03). The results generated from this work will be disseminated to academic audiences and the public via publications in international peer-reviewed journals and conferences. The data presented will be imported into a national data registry. Findings are expected to be available in 2025, which will facilitate clinical decision-making in the field. TRIAL REGISTRATION NUMBER NCT05015283.
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Affiliation(s)
- Mengyi Li
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yang Liu
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wei-Jei Lee
- Department of Surgery, Min-Sheng General Hospital, Taiwan, China
| | - Scott A Shikora
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Maud Robert
- Department of Digestive and Bariatric Surgery, Hôpital Edouard Herriot, Lyon, France
| | - Weu Wang
- Department of Surgery, Taipei Medical University Hospital, Taiwan, China
| | | | - Yuanyuan Kong
- Clinical Epidemiology & EBM Unit, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | | | - Chun Hai Tan
- Surgicare Bariatric and General Surgery Clinic, Singapore
| | - Na Zeng
- School of Public Health, Peking University, Beijing, China
| | - Shaihong Zhu
- Department of General Surgery, The Third Xiangya Hospital of Central South University, Hunan, China
| | - Cunchuan Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Jinan University, Guangdong, China
| | - Pin Zhang
- Division of Bariatric and Metabolic Surgery, Department of General Surgery, Shanghai Jiao Tong University affiliated Sixth People's Hospital, Shanghai, China
| | - Yan Gu
- Department of General Surgery, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Rixing Bai
- Department of General Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fanqiang Meng
- Department of General Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Zhongqi Mao
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Jiangsu, China
| | - Xiangwen Zhao
- Department of General Surgery, Xiaolan People's Hospital, Guangdong, China
| | - Liangping Wu
- Division of Metabolic and Bariatric Surgery, Department of General Surgery, Jinshazhou Hospital of Guangzhou, University of Chinese Medicine, Guangdong, China
| | - Yanjun Liu
- Center of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University & Research Center for Obesity and Metabolic Disease, School of Medicine, Southwest Jiaotong University, Sichuan, China
| | - Songhai Zhang
- Department of General Surgery, The First Affiliated Hospital of Henan University of Science and Technology, Henan, China
| | - Peng Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhongtao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Fink J, Seifert G, Blüher M, Fichtner-Feigl S, Marjanovic G. Obesity Surgery. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:70-80. [PMID: 34819222 PMCID: PMC9059860 DOI: 10.3238/arztebl.m2021.0359] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 03/27/2021] [Accepted: 10/07/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND In 2017, the prevalence of obesity (BMI ≥= 30 kg/m2) in Germany was approximately 16%. Obesity increases an individual's risk of developing type 2 diabetes (T2DM) and arterial hypertension; it also increases overall mortality. Consequently, effective treatment is a necessity. Approximately 20 000 bariatric operations are performed in Germany each year. METHODS This review is based on pertinent publications retrieved by a selective search in the PubMed and Cochrane databases and on current German clinical practice guidelines. RESULTS The types of obesity surgery most commonly performed in Germany, Roux-en-Y gastric bypass and sleeve gastrectomy, lead to an excess weight loss of 27-69% ≥= 10 years after the procedure. In obese patients with T2DM, the diabetes remission rate ≥= 10 years after these procedures ranges from 25% to 62%. Adjusted regression analyses of data from large registries have shown that the incidence of malignancies is 33% lower in persons who have undergone obesity surgery compared to control subjects with obesity (unadjusted incidence 5.6 versus 9.0 cases per 1000 person-years). The operation can cause vitamin deficiency, surgical complications, gastroesophageal reflux, and dumping syndrome. Therefore, lifelong follow-up is necessary. CONCLUSION In view of an increasing number of patients undergoing bariatric surgery, it will probably not be feasible in the future for lifelong follow-up to be provided exclusively in specialized centers.
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Affiliation(s)
- Jodok Fink
- Department of General and Visceral Surgery, Center for Obesity and Metabolic Surgery, Medical Center, University of Freiburg,*Klinik für Allgemein- und Viszeralchirurgie Sektion für Adipositas und Metabolische Chirurgie Universitätsklinikum Freiburg Hugstetter Str. 55, D-79106 Freiburg, Germany
| | - Gabriel Seifert
- Department of General and Visceral Surgery, Center for Obesity and Metabolic Surgery, Medical Center, University of Freiburg
| | - Matthias Blüher
- Helmholtz-Institute for Metabolic, Obesity and Vascular Research, (HI-MAG), Helmholtz Zentrum München at the University of Leipzig and the Medical Faculty of Leipzig AöR
| | - Stefan Fichtner-Feigl
- Department of General and Visceral Surgery, Center for Obesity and Metabolic Surgery, Medical Center, University of Freiburg
| | - Goran Marjanovic
- Department of General and Visceral Surgery, Center for Obesity and Metabolic Surgery, Medical Center, University of Freiburg
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Gentileschi P, Bianciardi E, Benavoli D, Campanelli M. Metabolic surgery for type II diabetes: an update. Acta Diabetol 2021; 58:1153-1159. [PMID: 34003378 PMCID: PMC8316162 DOI: 10.1007/s00592-021-01722-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 04/15/2021] [Indexed: 01/14/2023]
Abstract
Bariatric operations have been documented in clinical trials to promote remission or dramatic improvement of Type II Diabetes Mellitus and related comorbidities. Herein we review randomized trials and meta-analyses published during the last 20 years on the results of bariatric/metabolic surgery in obese patients with type 2 diabetes with the aim of highlighting the scientific evidence available. Several studies and RCTs in the last 20 years have showed outstanding results of bariatric/metabolic surgery on Type II diabetes and comorbidities in patients with either BMI > 35 kg/m2 or BMI < 35 kg/m2. They have established that bariatric procedures are superior to non-surgical interventions for inducing weight loss and amelioration of type 2 diabetes, even in patients with a BMI between 30 and 35 kg/m2. The physiopatologic changes that improve glucose homeostasis after bariatric surgery remain unclear but glycemic control is improved after sleeve gastrectomy, duodenal-jejunal bypass, Roux-en-Y gastric bypass, gastric banding, One Anastomosis Gastric Bypass, and biliopancreatic diversion. Nevertheless, it is suggested that the various gastrointestinal procedures may have different effects and mechanisms of action. Metabolic surgery will help integrate knowledge and multidisciplinary expertise to provide a combination of conservative and surgical treatments for Type II diabetes. These treatments must be considered as complementary options and not alternative strategies, with the same goal of controlling diabetes and achieving cure.
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Affiliation(s)
- Paolo Gentileschi
- Department of Bariatric and Metabolic Surgery, San Carlo of Nancy Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Emanuela Bianciardi
- Department of Systems Medicine, Chair of Psychiatry, University of Rome Tor Vergata, Rome, Italy
| | | | - Michela Campanelli
- Department of Bariatric and Metabolic Surgery, San Carlo of Nancy Hospital, University of Rome Tor Vergata, Rome, Italy.
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One-anastomosis gastric bypass (OAGB) in patients with BMI < 30 kg/m2 and diabetes mellitus type 2 (DM2). NUTR HOSP 2021; 38:971-977. [PMID: 34105979 DOI: 10.20960/nh.03545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION type-2 diabetes mellitus (DM2) is a major health problem, as it leads to increased morbidity and mortality. Metabolic surgery has shown good results in glycemic control; however, its use has not become popular. OBJECTIVES to evaluate DM2 remission, as well as changes in body mass index (BMI), in overweight diabetic patients after undergoing metabolic surgery. METHODS a retrospective review was carried out of all patients with DM2 and BMI between 25 and 29.9 kg/m2 who underwent laparoscopic one-anastomosis gastric bypass (OAGB) as metabolic procedure between 2016 and 2019. RESULTS a total of 15 patients were included with a mean age of 46.6 ± 11.25 years. Mean BMI was 28.41 ± 0.94 kg/m2. Average duration was 5.4 ± 2.79 years, and presurgical fasting glucose was 288.53 ± 65.22 mg/dL. Preoperative glycated hemoglobin (HbA1c) was 9.58 ± 1.66 %. Two years after surgery HbA1c was 5.21 ± 0.26 %. The remission rate of DM2 was 100 %. All patients maintained a normal BMI range. CONCLUSIONS OAGB is a valid alternative for complete DM2 remission no matter if it is not accompanied by some degree of obesity, since in this case the length of the biliopancreatic limb and common channel is modified to make a less malabsorptive procedure.
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