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Şişik A, Dalkılıç MS, Gençtürk M, Yılmaz M, Erdem H. Individualized Bariatric Surgery Utilizing Artificial Intelligence: A Call to Colleagues and New Year's Aspiration. Obes Surg 2024; 34:1380-1381. [PMID: 38206563 DOI: 10.1007/s11695-024-07060-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/01/2024] [Accepted: 01/07/2024] [Indexed: 01/12/2024]
Affiliation(s)
| | - Muhammed Said Dalkılıç
- Department of General Surgery, School of Medicine, Marmara University, Fevzi Çakmak Mahallesi Muhsin Yazıcıoğlu Caddesi No:10 Pendik, Istanbul, Turkey.
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Argetsinger S, LeCates RF, Zhang F, Ross-Degnan D, Wharam JF, Arterburn DE, Fernandez A, Lewis KH. Comparison of health care costs following sleeve gastrectomy versus Roux-en-Y gastric bypass among patients with type 2 diabetes. Obesity (Silver Spring) 2024; 32:691-701. [PMID: 38351395 PMCID: PMC11070223 DOI: 10.1002/oby.23997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/22/2023] [Accepted: 12/14/2023] [Indexed: 03/06/2024]
Abstract
OBJECTIVE The objective of this study was to compare the impact of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) on overall and diabetes-specific health care costs among patients with type 2 diabetes. METHODS This retrospective cohort study examined patients with type 2 diabetes after SG and RYGB using data from Optum's deidentified Clinformatics® Data Mart database. The matched study group included 9608 patients who underwent SG or RYGB and were enrolled between 2007 and 2019. The primary outcomes assessed were overall and diabetes-specific health care costs. RESULTS Health care costs associated with type 2 diabetes declined substantially in the first few years following both SG and RYGB. RYGB was associated with a larger decrease in pharmacy costs, as well as type 2 diabetes-specific office and laboratory costs. SG was associated with lower total health care costs in the first three follow-up periods and lower acute care costs in the first 2 years after surgery. CONCLUSIONS In this nationwide study, patients with type 2 diabetes at baseline undergoing RYGB appear to experience a reduced need for ambulatory type 2 diabetes monitoring and reduced requirements for antidiabetes medication but, despite this, did not experience an overall medical cost-benefit in the first few years after RYGB versus SG.
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Affiliation(s)
- Stephanie Argetsinger
- Division of Health Policy & Insurance Research, Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston MA
| | - Robert F LeCates
- Division of Health Policy & Insurance Research, Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston MA
| | - Fang Zhang
- Division of Health Policy & Insurance Research, Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston MA
| | - Dennis Ross-Degnan
- Division of Health Policy & Insurance Research, Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston MA
| | - James F. Wharam
- Division of Health Policy & Insurance Research, Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston MA
- Department of Medicine, Duke University, Durham, NC
- Duke-Margolis Center for Health Policy, Durham, NC
| | | | - Adolfo Fernandez
- Department of Surgery, Wake Forest University Health Sciences, Winston-Salem NC
| | - Kristina H. Lewis
- Department of Surgery, Wake Forest University Health Sciences, Winston-Salem NC
- Department of Epidemiology & Prevention, Department of Implementation Science, Division of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem NC
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Aguirre Talledo J, Caballero-Alvarado J, De la Cruz Davila M, Zavaleta-Corvera C. Roux-en-Y Gastric Bypass vs Vertical Sleeve Gastrectomy in the Remission of Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis. POLISH JOURNAL OF SURGERY 2024; 96:69-82. [PMID: 38940248 DOI: 10.5604/01.3001.0054.2674] [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] [Indexed: 06/29/2024]
Abstract
<b><br>Introduction:</b> Obesity's associated comorbidities and treatment costs have risen significantly, highlighting the importance of early weight loss strategies. Bariatric surgeries like Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) have been effective in promoting weight loss and improving type 2 diabetes mellitus (T2DM) management.</br> <b><br>Aim:</b> The aim was to determine whether Roux-en-Y gastric bypass is more effective than vertical sleeve gastrectomy in the remission of type 2 diabetes mellitus (T2DM).</br> <b><br>Methods:</b> A systematic review and meta-analysis was performed. A literature search was performed in the databases Web of Science, Medline/PubMed, Embase, Scopus, and Medline/Ovid. A total of 1323 results were identified; after screening, 14 articles were selected and included in the systematic review. Primary and secondary outcomes were measured by RR with a 95% CI.</br> <b><br>Results:</b> The primary outcome of T2DM remission was 15% in favor of VSG (RR: 1.15, [95% CI: 1.04-1.28]). For secondary outcomes, hypertension remission was 7% in favor of VSG (RR: 1.07, [95% CI: 1.00-1.16]). Remission of dyslipidemia was 16% in favor of VSG (RR: 1.16, [95% CI: 1.06-1.26]). BMI after surgery was in favor of RYGB (MD: -1.31, [95% CI: -1.98 to -0.64]). For weight loss, the results favored VSG (MD: 6.50, [95% CI: 4.99-8.01]). In relation to total cholesterol, they were 65% favorable for RYGB (MD: -0.35, [95% CI: -0.46 to -0.24]), with a value of p <0.05. For LDL values, our results were 69% favorable for RYGB (MD: -0.31, [95% CI: -0.45 to -0.16]), p <0.01 value.</br> <b><br>Conclusions:</b> Laparoscopic sleeve gastrectomy is more effective in T2DM remission, hypertension remission, dyslipidemia remission, and weight loss compared to Roux-en-Y gastric bypass. Roux-en-Y gastric bypass is more effective at lowering BMI, total cholesterol, LDL, and TG compared to laparoscopic sleeve gastrectomy.</br>.
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Affiliation(s)
| | - Jose Caballero-Alvarado
- School of Medicine, Antenor Orrego Private University, Trujillo, Peru, Surgery Department, Regional Hospital of Trujillo, Trujillo, Peru
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Chaiyasoot K, Sakai NS, Zakeri R, Makaronidis J, Crisóstomo L, Alves MG, Gan W, Firman C, Jassil FC, Hall-Craggs MA, Taylor SA, Batterham RL. Weight-loss Independent Clinical and Metabolic Biomarkers Associated with Type 2 Diabetes Remission Post-bariatric/metabolic Surgery. Obes Surg 2023; 33:3988-3998. [PMID: 37910328 PMCID: PMC10687127 DOI: 10.1007/s11695-023-06905-8] [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: 09/10/2023] [Revised: 10/04/2023] [Accepted: 10/11/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE Remission of type 2 diabetes (T2D) can be achieved by many, but not all, people following bariatric/metabolic surgery. The mechanisms underlying T2D remission remain incompletely understood. This observational study aimed to identify novel weight-loss independent clinical, metabolic and genetic factors that associate with T2D remission using comprehensive phenotyping. MATERIALS AND METHODS Ten patients without T2D remission (non-remitters) were matched to 10 patients with T2D remission (remitters) for age, sex, type of surgery, body weight, BMI, post-operative weight loss, duration from surgery and duration of T2D. Detailed body composition assessed using magnetic resonance imaging, gut hormones, serum metabolomics, insulin sensitivity, and genetic risk scores for T2D and anthropometric traits were assessed. RESULTS Remitters had significantly greater β-cell function and circulating acyl ghrelin levels, but lower visceral adipose tissue (VAT): subcutaneous adipose tissue (SAT) ratio than non-remitters. Branched-chain amino acids (BCAAs) and VLDL particle size were the most discriminant metabolites between groups. A significant positive correlation between, VAT area, VAT:SAT ratio and circulating levels of BCAAs was observed, whereas a significant negative correlation between BCAAs and β-cell function was revealed. CONCLUSION We highlight a potentially novel relationship between VAT and BCAAs, which may play a role in glucoregulatory control. Improvement in β-cell function, and the role ghrelin plays in its recovery, is likely another key factor influencing T2D remission post-surgery. These findings suggest that adjunctive approaches that target VAT loss and restoration of BCAA metabolism might achieve higher rates of long-term T2D remission post-surgery.
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Affiliation(s)
- Kusuma Chaiyasoot
- Department of Medicine, Centre for Obesity Research, University College London, London, UK
- Division of Nutrition, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- The Siriraj Center of Research Excellence for Diabetes and Obesity (SiCORE-DO), Mahidol University, Bangkok, Thailand
| | | | - Roxanna Zakeri
- Department of Medicine, Centre for Obesity Research, University College London, London, UK
| | - Janine Makaronidis
- Department of Medicine, Centre for Obesity Research, University College London, London, UK
- National Institute of Health Research, University College London Hospitals Biomedical Research Centre, London, UK
| | - Luís Crisóstomo
- Department of Immunophysiology and Pharmacology, ICBAS - School of Medicine and Biomedical Sciences, UMIB - Unit for Multidisciplinary Research in Biomedicine, University of Porto, Porto, Portugal
- ITR - Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Marco G Alves
- Department of Immunophysiology and Pharmacology, ICBAS - School of Medicine and Biomedical Sciences, UMIB - Unit for Multidisciplinary Research in Biomedicine, University of Porto, Porto, Portugal
- ITR - Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
| | - Wei Gan
- Genetics Department, Novo Nordisk Research Centre Oxford, Innovation Building, Old Road Campus, Headington, OX37LQ, UK
| | - Chloe Firman
- Department of Medicine, Centre for Obesity Research, University College London, London, UK
| | - Friedrich C Jassil
- Department of Medicine, Centre for Obesity Research, University College London, London, UK
| | - Margaret A Hall-Craggs
- UCL Centre for Medical Imaging, London, UK
- National Institute of Health Research, University College London Hospitals Biomedical Research Centre, London, UK
| | - Stuart A Taylor
- UCL Centre for Medical Imaging, London, UK
- National Institute of Health Research, University College London Hospitals Biomedical Research Centre, London, UK
| | - Rachel L Batterham
- Department of Medicine, Centre for Obesity Research, University College London, London, UK.
- National Institute of Health Research, University College London Hospitals Biomedical Research Centre, London, UK.
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Yu C, Wang Z, Wuyun Q, Chen W, Li Z, Shang M, Zhang N. Comparison of various prediction models in the effect of Roux-en-Y gastric bypass on type 2 diabetes in the Chinese population 5 years after surgery. Surg Obes Relat Dis 2023; 19:1288-1295. [PMID: 37716844 DOI: 10.1016/j.soard.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 04/18/2023] [Accepted: 05/06/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Various prediction models of type 2 diabetes (T2D) remission have been externally verified internationally. However, long-term validated results after Roux-en-Y gastric bypass (RYGB) surgery are lacking. The best model for the Chinese population is also unknown. OBJECTIVES To evaluate the prediction effect of various prediction models on the long-term diabetes remission after RYGB in the Chinese population and to provide reference for clinical use. SETTING A retrospective clinical study at a university hospital. METHODS We retrospectively analyzed Chinese population data 5 years after RYGB and externally validated 11 predictive models to evaluate the predictive effect of each model on long-term T2D remission after RYGB. RESULTS We enrolled 84 patients. The mean body mass index was 41 kg/m2, and the percentage of excess weight loss (%EWL) was 72.3%. The mean glycated hemoglobin level was 8.4% preoperatively and decreased to 5.9% after 5 years. The 5-year postoperative complete and partial remission rates of T2D were 31% and 70.2%, respectively. The ABCD scoring model (sensitivity, 84%; specificity, 76%; area under the curve [AUC], .866) and the Panuzi et al. [34] study (sensitivity, 84%; specificity, 81%; AUC, .842) showed excellent results. In the Hosmer-Lemeshow goodness-of-fit test, calibration values for ABCD and Panuzi et al. [34] were .14 and .21, respectively. The predicted-to-observed ratios of ABCD and Panuzi et al. [34] were .83 and .88, respectively. CONCLUSIONS T2D was relieved to varying degrees 5 years after RYGB in patients with obesity. The prediction models in ABCD and the Panuzi et al. [34] studies showed the best prediction effects. ABCD was recommended for clinical use because of excellent predictive performance, good statistical test results, and simple and practical design features.
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Affiliation(s)
- Chengyuan Yu
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine, Beijing, China
| | - Zheng Wang
- Department of Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Qiqige Wuyun
- Department of Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Weijian Chen
- Department of Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Zhehong Li
- Department of Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Mingyue Shang
- Department of Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Nengwei Zhang
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine, Beijing, China.
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Results of sleeve gastrectomy in obese patients with type 2 diabetes mellitus and impaired glucose tolerance: Retrospective cohort registry-based study. ACTA BIOMEDICA SCIENTIFICA 2023. [DOI: 10.29413/abs.2023-8.1.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
Background. In the available literature, the data on the positive effects of sleeve gastrectomy in treatment of type 2 diabetes mellitus (T2DM) and impaired glucose tolerance (IGT) become more common, however, they are heterogeneous and not always unambiguous.The aim. To analyze our own results of treatment of patients with type 2 diabetes mellitus and impaired glucose tolerance, who underwent sleeve gastrectomy.Materials and methods. Retrospective cohort registry-based study was carried out. From 2016 to April 2021, 29 (19 %) and 7 (4.6 %) patients with diagnosed T2DM and IGT respectively underwent surgery. Of these, sleeve gastrectomy was performed in 13 (44.8 %) patients with type 2 diabetes mellitus and in 5 (71.4 %) patients with IGT. The mean duration of follow-up for T2DM and IGT patients was 14.2 ± 12.3 and 11.2 ± 9.0 months respectively.Results. The mean %EWL (% excess weight loss) in patients with T2DM and IGT was 44.1 ± 17.3 and 51.5 ± 16.9 respectively, and the mean %TWL (% total weight loss) was 25.0 ± 8.0 and 27.8 ± 6.0 respectively. At the moment of observation, all patients had normal level of fasting blood glucose. The level of HbA1c in patients with type 2 diabetes before the surgery was 8.2 ± 1.6, after surgery, at the time of observation – 5.8 ± 0.5 (U = 4; p ≤ 0.01). Targeted HbA1c values was recorded in all 13 patients with type 2 diabetes.Conclusion. Our study shows the efficiency of sleeve gastrectomy both in terms of weight loss and of the remission for patients with T2DM and IGT.
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Abstract
In the 70years that bariatric surgery has existed, many different surgical procedures have been developed. Four procedures are officially accepted by all learned societies: adjustable gastric banding (AGB), sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB) and bilio-pancreatic diversion (BPD). Gastric banding has the lowest short-term surgical risk, but it has the highest re-operation rate. Compared to SG, RYGB presents about twice the risk of early complications. Late complications seem equivalent between the two procedures but studies with follow-up>10years are rarer for SG. SG has become the most commonly performed bariatric procedure worldwide, followed by RYGB, which is still the standard. BPD remains very marginal but the omega gastric bypass, an alternative technique that is still under evaluation, now competes with RYGB. The effectiveness of these different procedures on weight loss remains difficult to compare. SG and RYGB seem to be equivalent for weight loss results and remission of type-2 diabetes (T2DM). Their results are superior to AGB. Procedures that result in greater lengths of intestinal bypass (bilio-pancreatic diversion, omega bypass) seem to have a greater weight-loss effect but are burdened by more side effects. In conclusion, the choice of a procedure is conditioned firstly by the benefit-risk ratio and in relation to patient-related parameters, particularly the body mass index (BMI) and co-morbidities. Long-term results are also linked to factors other than surgery and in particular patient behavioral factors. Obesity is a chronic disease that indicates the need for real long-term medical and surgical management.
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Affiliation(s)
- P Topart
- Visceral Surgery Society, Anjou Clinic, 9, rue de l'Hirondelle, 49000 Angers, France.
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Bennett WC, Garbarine IC, Mostellar M, Lipman J, Sanchez-Casalongue M, Farrell T, Zhou R. Comparison of early post-operative complications in primary and revisional laparoscopic sleeve gastrectomy, gastric bypass, and duodenal switch MBSAQIP-reported cases from 2015 to 2019. Surg Endosc 2023; 37:3728-3738. [PMID: 36653536 DOI: 10.1007/s00464-022-09796-5] [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: 03/28/2022] [Accepted: 11/27/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Sleeve gastrectomy (SG) is now the most performed bariatric surgery, though gastric bypass (GB) and duodenal switch (DS) remain common, especially as conversion/revision (C/R) procedures. This analysis compared early postoperative outcomes of primary and C/R laparoscopic SG to DS and GB; and primary procedures of each vs C/R counterparts. METHODS The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) dataset was queried for SG, GB, and DS cases from 2015 to 2019. Multivariable logistic regression calculated crude and adjusted odds ratios for surgical site infection (SSI), reoperation, and readmission at 30 days in two initial comparisons: (1) primary SG vs DS or GB and (2) C/R SG vs DS or GB. A secondary analysis compared primary GS, GB, or DS with C/R counterparts. Models were adjusted for confounding demographics and comorbidities. RESULTS Of 755,968 primary cases, most were SG (72.8%), followed by GB (26.3%), then DS (0.9%). Compared to SG, GB and DS demonstrated higher odds of SSI (aOR 3.02 [2.84, 3.2]), readmission (aOR 1.97 [1.92, 2.03]), and reoperation (aOR 2.74 [2.62, 2.86]), respectively. Of 68,716 C/R cases, SG was most common (43.2%), followed by GB (37.5%), then DS (19.2%). C/R GB and DS demonstrated greater risk of SSI (aOR 2.28 [1.98, 2.62]), readmission (aOR 2.10 [1.94, 2.27]), and reoperation (aOR 2.3 [2.04, 2.59]) vs SG, respectively. C/R SG and DS demonstrated greater risk of SSI (OR 2.09 [1.66, 2.63]; 1.63 [1.24, 2.14), readmission (OR 1.13 [1.02, 1.26]), and reoperation (OR 1.27 [1.06, 1.52]; 1.58 [1.24, 2.0]), vs primary procedures. C/R DS demonstrated greater risk of SSI (OR 1.23 [1.66, 2.63]). CONCLUSIONS Early complications are comparable between GB and DS, and greater than SG. In C/R procedures, GB and DS demonstrate greater risk than SG. Overall, C/R procedures demonstrate greater risk of most, but not all, early postoperative complications.
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Affiliation(s)
- William C Bennett
- Department of Surgery, University of North Carolina School of Medicine, 4001 Burnett-Womack Building, CB #7050, Chapel Hill, NC, USA. .,Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Ian C Garbarine
- Department of Surgery, University of North Carolina School of Medicine, 4001 Burnett-Womack Building, CB #7050, Chapel Hill, NC, USA.,Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Murphy Mostellar
- Department of Surgery, University of North Carolina School of Medicine, 4001 Burnett-Womack Building, CB #7050, Chapel Hill, NC, USA
| | - Jeffrey Lipman
- Department of Surgery, University of North Carolina School of Medicine, 4001 Burnett-Womack Building, CB #7050, Chapel Hill, NC, USA.,Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA.,Hernia Center, NYC Health + Hospitals / Bellevue, New York, NY, USA
| | - Manuel Sanchez-Casalongue
- Department of Surgery, University of North Carolina School of Medicine, 4001 Burnett-Womack Building, CB #7050, Chapel Hill, NC, USA.,Rush Copley Medical Center, Rush University, Aurora, IL, USA
| | - Timothy Farrell
- Department of Surgery, University of North Carolina School of Medicine, 4001 Burnett-Womack Building, CB #7050, Chapel Hill, NC, USA
| | - Randal Zhou
- Department of Surgery, University of North Carolina School of Medicine, 4001 Burnett-Womack Building, CB #7050, Chapel Hill, NC, USA.,Division of Bariatric and Minimally Invasive Surgery, Yale School of Medicine, New Haven, CT, USA
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Samuels JM, Carmichael H, Beaty L, Colborn K, Rothchild K, Schoen JA. Demographic factors as determinant of selection of sleeve gastrectomy or gastric bypass for surgical weight loss. Surg Endosc 2022; 36:8154-8163. [PMID: 35477806 DOI: 10.1007/s00464-022-09247-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 04/07/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Use of sleeve gastrectomy (SG) for weight loss has grown exponentially; however, clear indications for SG versus Roux-en-Y gastric bypass (RNYGB) are lacking. Certain populations may be more likely to undergo SG due to its simpler technique and without clear clinical indications. We aim to examine underlying predictors of patients undergoing SG vs RNY across a single state. METHODS We queried the Colorado All Payers Claim Database for patients undergoing laparoscopic SG or RNY. Patient-level variables included patient demographics, comorbidities, distance traveled for surgery, and distressed communities index (DCI), a zip code-based measure of socioeconomic status. Hospital-level variables included annual bariatric surgery volume, academic status, and whether hospitals were a bariatric Center of Excellence. We performed mixed-effects logistic regression adjusting for demographics, insurance coverage, and comorbidities to compare odds of undergoing SG vs RNY, with a random effect for hospital. RESULTS 5,017 patients were included with 3,042 (60.6%) undergoing SG and 1,975 (39.4%) undergoing RNY. On multivariable analysis, patients with a high DCI were not more likely to undergo a SG (OR 1.18, CI 0.89-1.55, p = 0.25). However, patients who underwent surgery at hospitals serving the greatest proportion of those from highly distressed communities were significantly more likely to undergo SG (OR 4.22, CI 1.38-12.96, p = 0.01). Patients managed at Bariatric Centers of Excellence were less likely to undergo SG (OR 0.22, CI 0.07-0.62, p = 0.005). Patients with higher BMI, diabetes, or GERD were all more likely to undergo RNY. CONCLUSION While patients with high DCI were more likely to undergo SG on univariate analysis, these associations disappeared after addition of a hospital-level random effect, suggesting that disparities may be due access to surgeons or systems with preference for one procedure. However, hospitals serving a higher proportion of high-DCI patients are more likely to utilize SG.
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Affiliation(s)
- Jason M Samuels
- Department of Surgery, University of Colorado Anschutz, Aurora, CO, USA.
| | | | - Laurel Beaty
- Center for Innovative Design and Analysis, Colorado School of Public Health, Aurora, CO, USA
| | - Kathryn Colborn
- Department of Surgery, University of Colorado Anschutz, Aurora, CO, USA
| | - Kevin Rothchild
- Department of Surgery, University of Colorado Anschutz, Aurora, CO, USA
| | - Jonathan A Schoen
- Department of Surgery, University of Colorado Anschutz, Aurora, CO, USA
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Lauren BN, Lim F, Krikhely A, Taveras EM, Woo Baidal JA, Bellows BK, Hur C. Estimated Cost-effectiveness of Medical Therapy, Sleeve Gastrectomy, and Gastric Bypass in Patients With Severe Obesity and Type 2 Diabetes. JAMA Netw Open 2022; 5:e2148317. [PMID: 35157054 PMCID: PMC8845022 DOI: 10.1001/jamanetworkopen.2021.48317] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/21/2021] [Indexed: 12/16/2022] Open
Abstract
Importance Bariatric surgery is recommended for patients with severe obesity (body mass index ≥40) and type 2 diabetes (T2D). However, the most cost-effective treatment remains unclear and may depend on the patient's T2D severity. Objective To estimate the cost-effectiveness of medical therapy, sleeve gastrectomy (SG), and Roux-en-Y gastric bypass (RYGB) among patients with severe obesity and T2D, stratified by T2D severity. Design, Setting, and Participants This economic evaluation used a microsimulation model to project health and cost outcomes of medical therapy, SG, and RYGB over 5 years. Time horizons varied between 10 and 30 years in sensitivity analyses. Model inputs were derived from clinical trials, large cohort studies, national databases, and published literature. Probabilistic sampling of model inputs accounted for parameter uncertainty. Estimates of US adults with severe obesity and T2D were derived from the National Health and Nutrition Examination Survey. Data analysis was performed from January 2020 to August 2021. Exposures Medical therapy, SG, and RYGB. Main Outcomes and Measures Quality-adjusted life-years (QALYs), costs (in 2020 US dollars), and incremental cost-effectiveness ratios (ICERs) were projected, with future cost and QALYs discounted 3.0% annually. A strategy was deemed cost-effective if the ICER was less than $100 000 per QALY. The preferred strategy resulted in the greatest number of QALYs gained while being cost-effective. Results The model simulated 1000 cohorts of 10 000 patients, of whom 16% had mild T2D, 56% had moderate T2D, and 28% had severe T2D at baseline. The mean age of simulated patients was 54.6 years (95% CI, 54.2-55.0 years), 61.6% (95% CI, 60.1%-63.4%) were female, and 65.1% (95% CI, 63.6%-66.7%) were non-Hispanic White. Compared with medical therapy over 5 years, RYGB was associated with the most QALYs gained in the overall population (mean, 0.44 QALY; 95% CI, 0.21-0.86 QALY) and when stratified by baseline T2D severity: mild (mean, 0.59 QALY; 95% CI, 0.35-0.98 QALY), moderate (mean, 0.50 QALY; 95% CI, 0.25-0.88 QALY), and severe (mean, 0.30 QALY; 95% CI, 0.07-0.79 QALY). RYGB was the preferred strategy in the overall population (ICER, $46 877 per QALY; 83.0% probability preferred) and when stratified by baseline T2D severity: mild (ICER, $36 479 per QALY; 73.7% probability preferred), moderate (ICER, $37 056 per QALY; 85.6% probability preferred), and severe (ICER, $98 940 per QALY; 40.2% probability preferred). The cost-effectiveness of RYGB improved over a longer time horizon. Conclusions and Relevance These findings suggest that the effectiveness and cost-effectiveness of bariatric surgery vary by baseline severity of T2D. Over a 5-year time horizon, RYGB is projected to be the preferred treatment strategy for patients with severe obesity regardless of baseline T2D severity.
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Affiliation(s)
- Brianna N. Lauren
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Francesca Lim
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Abraham Krikhely
- Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | - Elsie M. Taveras
- Division of General Academic Pediatrics, Massachusetts General Hospital, Boston
| | | | - Brandon K. Bellows
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Chin Hur
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
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Yeung KTD, Penney N, Whiley L, Ashrafian H, Lewis MR, Purkayastha S, Darzi A, Holmes E. The impact of bariatric surgery on serum tryptophan-kynurenine pathway metabolites. Sci Rep 2022; 12:294. [PMID: 34996930 PMCID: PMC8741964 DOI: 10.1038/s41598-021-03833-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 12/03/2021] [Indexed: 11/09/2022] Open
Abstract
This study aims to explore the immediate effects of bariatric surgery on serum tryptophan–kynurenine pathway metabolites in individuals with type 2 diabetes and BMI > 30. With the goal of providing insight into the link between tryptophan pathway metabolites, type 2 diabetes, and chronic obesity-induced inflammation. This longitudinal study included 20 participants. Half were diagnosed with type 2 diabetes. 11 and 9 underwent RYGB and SG respectively. Blood samples were obtained at pre-operative and 3 months post-operative timepoints. Tryptophan and downstream metabolites of the kynurenine pathway were quantified with an ultrahigh-performance liquid chromatography tandem mass spectrometry with electrospray ionisation method. At 3 months post-operation, RYGB led to significant reductions in tryptophan, kynurenic acid and xanthurenic acid levels when compared to baseline. Significant reductions of the same metabolites after surgery were also observed in individuals with T2D irrespective of surgical procedure. These metabolites were significantly correlated with serum HbA1c levels and BMI. Bariatric surgery, in particular RYGB reduces serum levels of tryptophan and its downstream kynurenine metabolites. These metabolites are associated with T2D and thought to be potentially mechanistic in the systemic processes of obesity induced inflammation leading to insulin resistance. Its reduction after surgery is associated with an improvement in glycaemic control (HbA1c).
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Affiliation(s)
- Kai Tai Derek Yeung
- Department of Surgery & Cancer, Imperial College London, South Kensington, London, UK
| | - Nicholas Penney
- Department of Surgery & Cancer, Imperial College London, South Kensington, London, UK
| | - Luke Whiley
- Department of Surgery & Cancer, Imperial College London, South Kensington, London, UK.,Australian National Phenome Centre & Centre for Computational & Systems Medicine, Health Futures Institute, Murdoch University, Perth, WA, Australia.,Department of Metabolism, Digestion and Reproduction, Imperial College London, South Kensington, London, UK
| | - Hutan Ashrafian
- Department of Surgery & Cancer, Imperial College London, South Kensington, London, UK
| | - Matthew R Lewis
- National Phenome Centre, Imperial College London, South Kensington, London, UK.,Department of Metabolism, Digestion and Reproduction, Imperial College London, South Kensington, London, UK
| | - Sanjay Purkayastha
- Department of Surgery & Cancer, Imperial College London, South Kensington, London, UK
| | - Ara Darzi
- Department of Surgery & Cancer, Imperial College London, South Kensington, London, UK
| | - Elaine Holmes
- Department of Surgery & Cancer, Imperial College London, South Kensington, London, UK. .,Australian National Phenome Centre & Centre for Computational & Systems Medicine, Health Futures Institute, Murdoch University, Perth, WA, Australia.
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12
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Aminian A, Wilson R, Zajichek A, Tu C, Wolski KE, Schauer PR, Kattan MW, Nissen SE, Brethauer SA. Cardiovascular Outcomes in Patients With Type 2 Diabetes and Obesity: Comparison of Gastric Bypass, Sleeve Gastrectomy, and Usual Care. Diabetes Care 2021; 44:2552-2563. [PMID: 34503954 DOI: 10.2337/dc20-3023] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 07/29/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine which one of the two most common metabolic surgical procedures is associated with greater reduction in risk of major adverse cardiovascular events (MACE) in patients with type 2 diabetes mellitus (T2DM) and obesity. RESEARCH DESIGN AND METHODS A total of 13,490 patients including 1,362 Roux-en-Y gastric bypass (RYGB), 693 sleeve gastrectomy (SG), and 11,435 matched nonsurgical patients with T2DM and obesity who received their care at the Cleveland Clinic (1998-2017) were analyzed, with follow-up through December 2018. With multivariable Cox regression analysis we 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. RESULTS The cumulative incidence of the primary end point at 5 years was 13.7% (95% CI 11.4-15.9) in the RYGB groups and 24.7% (95% CI 19.0-30.0) in the SG group, with an adjusted hazard ratio (HR) of 0.77 (95% CI 0.60-0.98, P = 0.04). Of the six individual end points, RYGB was associated with a significantly lower cumulative incidence of nephropathy at 5 years compared with SG (2.8% vs. 8.3%, respectively; HR 0.47 [95% CI 0.28-0.79], P = 0.005). Furthermore, RYGB was associated with a greater reduction in body weight, glycated hemoglobin, and use of medications to treat diabetes and cardiovascular diseases. Five years after 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) compared with SG. CONCLUSIONS In patients with obesity and T2DM, RYGB may be associated with greater weight loss, better diabetes control, and lower risk of MACE and nephropathy compared with SG.
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Affiliation(s)
- Ali Aminian
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH
| | - Rickesha Wilson
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH
| | - Alexander Zajichek
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Chao Tu
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Kathy E Wolski
- Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | | | - Michael W Kattan
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Steven E Nissen
- Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Stacy A Brethauer
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
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13
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Shikora SA, Edgerton C, Harris D, Buchwald H. Metabolic surgery. Curr Probl Surg 2021; 59:101059. [DOI: 10.1016/j.cpsurg.2021.101059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 09/03/2021] [Indexed: 11/29/2022]
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14
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Kukla A, Ventura-Aguiar P, Cooper M, de Koning EJP, Goodman DJ, Johnson PR, Han DJ, Mandelbrot DA, Pavlakis M, Saudek F, Vantyghem MC, Augustine T, Rickels MR. Transplant Options for Patients With Diabetes and Advanced Kidney Disease: A Review. Am J Kidney Dis 2021; 78:418-428. [PMID: 33992729 DOI: 10.1053/j.ajkd.2021.02.339] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 02/21/2021] [Indexed: 02/06/2023]
Abstract
Optimal glycemic control in kidney transplant recipients with diabetes is associated with improved morbidity and better patient and allograft survival. Transplant options for patients with diabetes requiring insulin therapy and chronic kidney disease who are suitable candidates for kidney transplantation should include consideration of β-cell replacement therapy: pancreas or islet transplantation. International variation related to national regulatory policies exists in offering one or both options to suitable candidates and is further affected by pancreas/islet allocation policies and transplant waiting list dynamics. The selection of appropriate candidates depends on patient age, coexistent morbidities, the timing of referral to the transplant center (predialysis versus on dialysis) and availability of living kidney donors. Therefore, early referral (estimated glomerular filtration rate < 30 mL/min/1.73 m2) is of the utmost importance to ensure adequate time for informed decision making and thorough pretransplant evaluation. Obesity, cardiovascular disease, peripheral vascular disease, smoking, and frailty are some of the conditions that need to be addressed before acceptance on the transplant list, and ideally before dialysis becoming imminent. This review offers insights into selection of pancreas/islet transplant candidates by transplant centers and an update on posttransplant outcomes, which may have practice implications for referring nephrologists.
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Affiliation(s)
- Aleksandra Kukla
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | | | | | - Eelco J P de Koning
- Department of Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - David J Goodman
- Department of Nephrology, St. Vincent's Hospital, Melbourne, Australia
| | - Paul R Johnson
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Duck J Han
- Division of Transplantation, Department of Surgery, Asan Medical Center, Seoul, South Korea
| | - Didier A Mandelbrot
- Division of Nephrology, Department of Medicine, University of Wisconsin, Madison, WI
| | - Martha Pavlakis
- Division of Nephrology, Department of Medicine, Beth Isreal Deaconess Medical Center, Boston, MA
| | - Frantisek Saudek
- Diabetes Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Marie-Christine Vantyghem
- CHU Lille, Department of Endocrinology, Diabetology and Metabolism, Inserm U1190, Translational Research for Diabetes, Univ Lille, European Genomic Institute for Diabetes, Lille, France
| | - Titus Augustine
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology Medicine and Health, Manchester Academic Health Centre, University of Manchester, Manchester, United Kingdom.
| | - Michael R Rickels
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
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15
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Castellana M, Procino F, Biacchi E, Zupo R, Lampignano L, Castellana F, Sardone R, Palermo A, Cesareo R, Trimboli P, Giannelli G. Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy for Remission of Type 2 Diabetes. J Clin Endocrinol Metab 2021; 106:922-933. [PMID: 33051679 DOI: 10.1210/clinem/dgaa737] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/09/2020] [Indexed: 02/07/2023]
Abstract
CONTEXT Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the bariatric procedures most commonly used for the management of obesity. Whether one or the other is associated with a higher chance of remission of type 2 diabetes (T2D) is unclear. OBJECTIVE This work aims to compare the efficacy of RYGB and SG for T2D remission at 1, 3, and 5 years after surgery. DATA SOURCES Four databases were searched until January 2020. STUDY SELECTION Randomized controlled studies with at least 12 months of follow-up of patients with T2D allocated to RYGB or SG were selected. DATA EXTRACTION To ensure uniformity, broad and narrow criteria for T2D remission were defined. The number of patients achieving remission of T2D at each assessment was extracted. Data were pooled using a random-effects model. DATA SYNTHESIS Ten studies were included, evaluating 778 patients. The overall prevalence of achievement of broad and narrow criteria for T2D remission was 73% and 53% at the 1-year, 60% and 48% at the 3-year, and 51% and 43% at the 5-year assessment. Compared to SG, RYGB was associated with a higher chance of achieving broad and narrow criteria for remission at 1 year after surgery (risk ratio [RR] = 1.34 vs RR = 1.22) and broad criteria for remission at 5 years (RR = 1.18). No other differences were found. CONCLUSIONS The present meta-analysis suggests a more favorable effect of RYGB than SG on achieving T2D remission in the short-term only, although the evidence currently available does not clarify whether differences in this outcome are confirmed long term or fade thereafter.
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Affiliation(s)
- Marco Castellana
- Population Health Unit National Institute of Gastroenterology "Saverio de Bellis," Research Hospital, Castellana Grotte, Bari, Italy
| | - Filippo Procino
- Population Health Unit National Institute of Gastroenterology "Saverio de Bellis," Research Hospital, Castellana Grotte, Bari, Italy
| | - Elisa Biacchi
- Ambulatori Multisito per la cura del sovrappeso e dell'obesità, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Roberta Zupo
- Population Health Unit National Institute of Gastroenterology "Saverio de Bellis," Research Hospital, Castellana Grotte, Bari, Italy
| | - Luisa Lampignano
- Population Health Unit National Institute of Gastroenterology "Saverio de Bellis," Research Hospital, Castellana Grotte, Bari, Italy
| | - Fabio Castellana
- Population Health Unit National Institute of Gastroenterology "Saverio de Bellis," Research Hospital, Castellana Grotte, Bari, Italy
| | - Rodolfo Sardone
- Population Health Unit National Institute of Gastroenterology "Saverio de Bellis," Research Hospital, Castellana Grotte, Bari, Italy
| | - Andrea Palermo
- Unità Operativa Malattie Metaboliche, Campus Bio-Medico University, Roma, Italy
| | | | - Pierpaolo Trimboli
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Scienze Biomediche, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Gianluigi Giannelli
- National Institute of Gastroenterology "Saverio de Bellis," Research Hospital, Castellana Grotte, Bari, Italy
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16
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Wilson R, Aminian A, Tahrani AA. Metabolic surgery: A clinical update. Diabetes Obes Metab 2021; 23 Suppl 1:63-83. [PMID: 33621412 DOI: 10.1111/dom.14235] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/11/2020] [Accepted: 10/23/2020] [Indexed: 02/06/2023]
Abstract
Metabolic and bariatric surgery has grown beyond 'experimental' weight-loss surgery. As techniques have advanced over the last few decades, so has the growing body of research and evidence, proving that both weight-loss and metabolic health improvement are induced. Metabolic surgery has become the more appropriate term for weight-loss surgery because of the altered gastrointestinal anatomy and subsequent beneficial metabolic effects. Although the tool of metabolic surgery has been well refined, a large portion of the global population does not have adequate access to it. This clinical update aims to (a) inform healthcare providers from all disciplines about the myriad of benefits of metabolic surgery and (b) equip them with the necessary knowledge to bridge the gap between patients in need of metabolic treatment and the therapies in metabolic surgery available to them.
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Key Words
- adjustable gastric banding, atrial fibrillation, bariatric surgery, cancer, cardiovascular disease, gastric bypass, heart failure, hypertension, mortality, obesity, obstructive sleep apnoea, reflux disease, sleeve gastrectomy, type 2 diabetes
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Affiliation(s)
- Rickesha Wilson
- Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ali Aminian
- Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Abd A Tahrani
- Institute of Metabolism and Systems Research (IMSR), University of Birmingham, Birmingham, UK
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism (CEDAM), Birmingham Health Partners, Birmingham, UK
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17
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Andalib A, Bouchard P, Demyttenaere S, Ferri LE, Court O. Esophageal cancer after sleeve gastrectomy: a population-based comparative cohort study. Surg Obes Relat Dis 2020; 17:879-887. [PMID: 33547014 DOI: 10.1016/j.soard.2020.12.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/11/2020] [Accepted: 12/21/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Sleeve gastrectomy (SG) is the most common bariatric surgery; however, this approach may induce gastroesophageal reflux disease (GERD). Both obesity and GERD are independent risk factors for esophageal cancer, however the impact of SG on risk of esophageal cancer remains unknown. OBJECTIVE To evaluate the risk of esophageal cancer after reflux-prone bariatric surgery. SETTING Population-level, provincial administrative healthcare database, Quebec, Canada. METHODS We identified a population-based cohort of all patients with obesity who underwent reflux-prone surgery (SG and duodenal switch [DS]) or reflux-protective Roux-en-Y gastric bypass (RYGB) during 01/2006-12/2012 in Quebec, Canada. For every surgical patient, 2-3 nonsurgical controls with obesity matched for age, sex, and geography were also identified. Crude incidence rate ratios (IRRs) for esophageal cancer were calculated using person-time analysis. Hazard ratios (HRs) were obtained using multivariate cox regression. RESULTS A total of 4121 patients had reflux-prone procedures and 852 underwent RYGB. At a mean follow-up of 7.6 years, 8 cases of esophageal cancer were identified after bariatric surgery. Compared with RYGB, IRR for esophageal cancer in reflux-prone group was 1.45 (95%CI: .19-65.5) and HR = .83 (95%CI: .10-7.27). The crude incidence rate of esophageal cancer in the reflux-prone group was higher than that of nonsurgical controls (n = 12,159; IRR = 3.46, 95%CI: 1.00-12.5), but after adjustment the difference disappeared (HR = 2.47, 95%CI: .82-7.45). CONCLUSIONS Long-term incidence of esophageal cancer after reflux-prone bariatric surgery is not greater than RYGB. While crude incidence of esophageal cancer after reflux-prone surgery is higher than in nonsurgical patients with obesity, such difference disappears after accounting for confounders. Given the low incidence of esophageal cancer and slow progression of dysplastic Barrett esophagus, studies with longer follow-up are needed.
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Affiliation(s)
- Amin Andalib
- Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, Canada.
| | - Philippe Bouchard
- Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, Canada
| | - Sebastian Demyttenaere
- Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, Canada
| | - Lorenzo E Ferri
- Division of Thoracic Surgery, Department of Surgery, McGill University, Montreal, Canada
| | - Olivier Court
- Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, Canada
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18
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Våge V. Selecting a metabolic procedure. Surg Obes Relat Dis 2020; 16:1879. [PMID: 32943321 DOI: 10.1016/j.soard.2020.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 07/30/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Villy Våge
- Scandinavian Obesity Surgery Registry, Helse Bergen Health Thrust, Bergen, Norway, Norway
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19
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Andalib A, Alamri H, Almuhanna Y, Bouchard P, Demyttenaere S, Court O. Short-term outcomes of revisional surgery after sleeve gastrectomy: a comparative analysis of re-sleeve, Roux en-Y gastric bypass, duodenal switch (Roux en-Y and single-anastomosis). Surg Endosc 2020; 35:4644-4652. [DOI: 10.1007/s00464-020-07891-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 08/05/2020] [Indexed: 01/07/2023]
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20
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Landin M, Sudan R. This Is How We Do It: Laparoscopic Roux-en-Y Gastric Bypass. J Laparoendosc Adv Surg Tech A 2020; 30:619-622. [DOI: 10.1089/lap.2020.0155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- MacKenzie Landin
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Ranjan Sudan
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
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21
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Aminian A. Roux-en-Y gastric bypass or sleeve gastrectomy for type 2 diabetes: expanding role of individualized metabolic surgery score. Surg Obes Relat Dis 2020; 16:972-973. [PMID: 32360113 DOI: 10.1016/j.soard.2020.03.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 03/23/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Ali Aminian
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio
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22
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Cohen R. Selecting surgical procedures for medically uncontrolled type 2 diabetes. Surg Obes Relat Dis 2020; 16:969-972. [PMID: 32331998 DOI: 10.1016/j.soard.2020.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/02/2020] [Indexed: 12/28/2022]
Affiliation(s)
- Ricardo Cohen
- The Center for the Treatment of Obesity and Diabetes, Hospital Oswaldo Cruz, Sao Paulo, Brazil
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