Long-term outcomes after biliopancreatic diversion with and without duodenal switch: 2-, 5-, and 10-year data

Sethi, Monica; Chau, Edward; Youn, Allison; Jiang, Yan; Fielding, George; Ren-Fielding, Christine

doi:10.1016/j.soard.2016.03.006

Cited by 78 publications

(34 citation statements)

References 28 publications

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“…However, biliopancreatic diversion use in the US and worldwide is limited due to the higher risk of macro-and micronutrient malnutrition in the long term reported in many series. 29,30 Although several earlier groups have reported marked improvements in T2D within weeks or even days after RYGB and often before massive weight loss occurs, 31,32 results from these RCTs and of cohort studies such as ours collectively support the notion that greater weight loss is associated with a higher likelihood of T2D remission. In addition to the association between greater 1-year weight loss and improved remission rates, we found that patients who achieved remission were less likely to relapse if they avoided significant weight regain (Table 3).…”

Section: Discussionsupporting

confidence: 53%

Factors Mediating Type 2 Diabetes Remission and Relapse after Gastric Bypass Surgery

Pessoa

Browning

Mazzini

et al. 2020

Journal of the American College of Surgeons

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BACKGROUND: Defining factors associated with remission and relapse of type 2 diabetes (T2D) after Rouxen-Y gastric bypass (RYGB) can allow targeting modifiable factors. We investigated factors associated with T2D remission and relapse after RYGB. STUDY DESIGN: We conducted a retrospective review of consecutive patients with T2D who underwent RYGB between 1993 and 2017. T2D remission was defined as medication discontinuation and/or hemoglobin A1c <6.5%. Relapse was defined as recurrence medication use and/or hemoglobin A1c !6.5%. Independent correlates of T2D remission and relapse were identified using logistic regression. RESULTS: Six hundred and twenty-one patients (aged 46.7 AE 10.6 years; 30% on insulin; BMI 49.8 AE 8.3 kg/m 2) had at least 1-year follow-up. Median follow-up was 4.9 years (range 1 to 23.6 years). Prevalence of T2D remission was 74% at 1 year, 73% from 1 to 3 years, 63% between 3 and 10 years, and 47% beyond 10 years. Ninety-three percent of remissions occurred within 3 years of RYGB, 25% relapsed. Median time to relapse was 5.3 years (interquartile range 3 to 7.8 years) after remission. Higher 1-year percentage total body weight loss, lack of preoperative insulin use, and younger age at operation were independently associated with T2D remission. Preoperative insulin use, lower percentage total body weight loss at 1 year, and greater percentage total body weight regain after 1 year were independently associated with T2D relapse. CONCLUSIONS: This longitudinal retrospective analysis shows that preoperative insulin use and age, 1-year weight loss, and regain after that influence T2D remission and relapse after RYGB. Referring patients at a younger age, before insulin is needed, and optimizing weight loss and preventing weight regain after RYGB can improve the rates and durability of T2D remission.

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Section: Discussionsupporting

confidence: 53%

Factors Mediating Type 2 Diabetes Remission and Relapse after Gastric Bypass Surgery

Pessoa

Browning

Mazzini

et al. 2020

Journal of the American College of Surgeons

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“…years%EWL at max. yearsReoperation %Hess, 2005 [43]DS13009210167753.4Scopinaro, 2005 [44]BPD312781024373NRLarrad-Jiminez, 2007 [45]BPD34368106570NRBallesteros-Pomar 2016 [46]BPD29981103464NRBolckmans, 2016 [47]DS15379101139443Camerini, 2016 [48]BPD12065157967NRSethi, 2016 [49]DS1007210566837Pata, 2013 [50]DS8743810–15 years3287830+Topart, 2017 [51]DS8073Jan-00647311Marceau, 2007 [52]DS1323NRJan-002846921+White, 2017 [53]DS170NR10+2361NR…”

Section: Resultsmentioning

confidence: 99%

Long-Term Outcomes After Bariatric Surgery: a Systematic Review and Meta-analysis of Weight Loss at 10 or More Years for All Bariatric Procedures and a Single-Centre Review of 20-Year Outcomes After Adjustable Gastric Banding

et al. 2018

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IntroductionDurability is a key requirement for the broad acceptance of bariatric surgery. We report on durability at and beyond 10 years with a systematic review and meta-analysis of all reports providing data at 10 or more years and a single-centre study of laparoscopic adjustable gastric banding (LAGB) with 20 years of follow-up.MethodsSystematic review with meta-analysis was performed on all eligble reports containing 10 or more years of follow-up data on weight loss after bariatric surgery. In addition, a prospective cohort study of LAGB patients measuring weight loss and reoperation at up to 20 years is presented.ResultsSystematic review identified 57 datasets of which 33 were eligible for meta-analysis. Weighted means of the percentage of excess weight loss (%EWL) were calculated for all papers included in the systematic review. Eighteen reports of gastric bypass showed a weighted mean of 56.7%EWL, 17 reports of LAGB showed 45.9%EWL, 9 reports of biliopancreatic bypass +/− duodenal switch showed 74.1%EWL and 2 reports of sleeve gastrectomy showed 58.3%EWL. Meta-analyses of eligible studies demonstrated comparable results. Reoperations were common in all groups. At a single centre, 8378 LAGB patients were followed for up to 20 years with an overall follow-up rate of 54%. No surgical deaths occurred. Weight loss at 20 years (N = 35) was 30.1 kg, 48.9%EWL and 22.2% total weight loss (%TWL). Reoperation rate was initially high but reduced markedly with improved band and surgical and aftercare techniques.ConclusionAll current procedures are associated with substantial and durable weight loss. More long-term data are needed for one-anastomosis gastric bypass and sleeve gastrectomy. Reoperation is likely to remain common across all procedures.

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“…However, significant malabsorption complications and difficulty in laparoscopic surgery prevent the wide usage of this procedure 17. Long‐term (>10 years) weight loss after BPD/DS was reported to be around 40% total weight loss and 80% EWL 42, 43. Revision surgery was required in 37% of the patients 43…”

Section: New Procedures With Better Outcomesmentioning

confidence: 99%

“…It is a thin flexible 60‐cm‐long tube that is delivered endoscopically and creates a physical barrier between ingested food and the duodenum/proximal jejunum. Endoscopic suturing technique was applied in the endoscopic sleeve 81 or for salvage purposes 42, 43…”

Section: New Procedures With Better Outcomesmentioning

confidence: 99%

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Recent advancements in bariatric/metabolic surgery

Lee

Almalki

2017

Annals of Gastroent Surgery

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Obesity and type 2 diabetes mellitus (T2DM) are currently two pan‐endemic health problems worldwide and are associated with considerable increase in morbidity and mortality. Both diseases are closely related and very difficult to control by current medical treatment, including diet, drug therapy and behavioral modification. Bariatric surgery has proven successful in treating not just obesity but also in significantly decreasing overall obesity‐associated morbidities as well as improving quality of life in severely obese patients (body mass index [BMI] >35 kg/m2). A rapid increase in bariatric surgery started in the 2000s when the laparoscopic surgical technique was introduced into this field. Many new procedures had been developed and changed the face of modern bariatric surgery. Recently, bariatric surgery played as gastrointestinal metabolic surgery has been proposed as a new treatment modality for obesity‐related T2DM for patients with BMI >35 kg/m2. Strong evidence has demonstrated that bariatric/metabolic surgery is an effective and durable treatment for obese T2DM patients. Bariatric/metabolic surgery is now becoming an important surgical division. The present article examines and discusses recent advancements in bariatric/metabolic surgery and covers four major fields: (i) the rapid increase in numbers and better safety; (ii) new procedures with better outcomes; (iii) from bariatric to metabolic surgery; and (iv) understanding the mechanisms and personalized treatment.

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Long-term outcomes after biliopancreatic diversion with and without duodenal switch: 2-, 5-, and 10-year data

Cited by 78 publications

References 28 publications

Factors Mediating Type 2 Diabetes Remission and Relapse after Gastric Bypass Surgery

Factors Mediating Type 2 Diabetes Remission and Relapse after Gastric Bypass Surgery

Long-Term Outcomes After Bariatric Surgery: a Systematic Review and Meta-analysis of Weight Loss at 10 or More Years for All Bariatric Procedures and a Single-Centre Review of 20-Year Outcomes After Adjustable Gastric Banding

Recent advancements in bariatric/metabolic surgery

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