Deep brain stimulation compared with bariatric surgery for the treatment of morbid obesity: a decision analysis study

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Roux-en-Y gastric bypass is the gold standard treatment for morbid obesity, although failure rates may be high, particularly in patients with a BMI &gt; 50 kg/m<jats:sup>2</jats:sup>. With improved understanding of the neuropsychiatric basis of obesity, deep brain stimulation (DBS) offers a less invasive and reversible alternative to available surgical treatments. In this decision analysis, the authors determined the success rate at which DBS would be equivalent to the two most common bariatric surgeries.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Medline searches were performed for studies of laparoscopic adjustable gastric banding (LAGB), laparoscopic Roux-en-Y gastric bypass (LRYGB), and DBS for movement disorders. Bariatric surgery was considered successful if postoperative excess weight loss exceeded 45% at 1-year follow-up. Using complication and success rates from the literature, the authors constructed a decision analysis model for treatment by LAGB, LRYGB, DBS, or no surgical treatment. A sensitivity analysis in which major parameters were systematically varied within their 95% CIs was used.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Fifteen studies involving 3489 and 3306 cases of LAGB and LRYGB, respectively, and 45 studies involving 2937 cases treated with DBS were included. The operative successes were 0.30 (95% CI 0.247–0.358) for LAGB and 0.968 (95% CI 0.967–0.969) for LRYGB. Sensitivity analysis revealed utility of surgical complications in LRYGB, probability of surgical complications in DBS, and success rate of DBS as having the greatest influence on outcomes. At no values did LAGB result in superior outcomes compared with other treatments.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Deep brain stimulation must achieve a success rate of 83% to be equivalent to bariatric surgery. This high-threshold success rate is probably due to the reported success rate of LRYGB, despite its higher complication rate (33.4%) compared with DBS (19.4%). The results support further research into the role of DBS for the treatment of obesity.</jats:p></jats:sec>

Hypothalamic Deep Brain Stimulation Influences Autonomic and Limbic Circuitry Involved in the Regulation of Aggression and Cardiocerebrovascular Control in the Göttingen Minipig

“…Furthermore, animal studies have demonstrated that the ventromedial and lateral hypothalamus are implicated in the regulation of feeding and energy metabolism and therefore considered as possible targets for clinical DBS aimed at treating morbid obesity [1,2,3,4]. …”

“…Hypothalamic neuromodulation for obesity control has been considered ever since the rise and fall of the simplistic dual center model which hypothesized that control of eating resided in the interaction between ventromedial hypothalamic satiety and lateral hypothalamic feeding centers [1,2,3,4]. However, due to the functional complexity and closely adjoined nervous structures in the hypothalamus, therapeutic beneficial hypothalamic deep brain stimulation (DBS) may in addition influence normal central homeostatic control, due to the involvement of overlapping limbic and autonomic networks.…”

Deep brain stimulation for obesity: rationale and approach to trial design

“…Pisapia et al conducted a decision analysis comparing the two major surgical options for obesity: laparoscopic Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding. 65 Laparoscopic banding was found to not be effective at achieving successful weight loss (defined as at least 45% of excess weight), and the complication rates for gastric bypass surgery (33%) far exceeded those of DBS (19%). These reports characterize DBS in obesity as a promising therapeutic avenue from an economic standpoint.…”

Deep brain stimulation: a mechanistic and clinical update

“…While gastric bypass is currently the gold standard therapy for morbid obesity, a recent study used decision analysis to note that DBS for obesity would only need an 83% success rate to achieve equivalence to bypass surgery. 162 Anorexia nervosa is another psychiatric disorder involving limbic circuits. Up to 70% of patients suffering from anorexia have a chronic refractory course, and it is one of the deadliest psychiatric disorders, with a mortality rate of 10%.…”