October 20, 2011 Margaux Añel-Tiangco, MD

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Presentation transcript:

October 20, 2011 Margaux Añel-Tiangco, MD Diabetes Journal Club October 20, 2011 Margaux Añel-Tiangco, MD

Introduction 1/3 of pts who have bariatric surgery in the US has a BMI >50 kg/m2 (called superobesity) After RYGB and achieving peak weight loss, these pts still have a BMI >35 kg/m2 Evidence from non-RCTs suggest that duodenal switch may lead to greater wt loss than RYGB

Methods Recruitment from March 2006-August 2007 with 2-year follow-up completed in November 2009 2 university hospitals in Norway and Sweden Inclusion criteria: BMI 50-60 kg/m2 Age 20-50 years Had not sustained previous wt loss

Roux-en-Y Gastric Bypass 25 mL 150 cm 50 cm

Duodenal Switch 200 cm 100 cm

Roux-en-Y vs. Duodenal Switch

Study Flow Diagram

Baseline Characteristics

Changes in Weight and BMI Health related quality of life – no significant difference between the two groups

Changes in Cholesterol Levels -9.27 mg/dL 32.0 mg/dL -41.3 mg/dL -10.0 mg/dL 20.5 mg/dL -30.1 mg/dL

Adverse Events

Adverse Events Lower vitamin A and 25-OHD in the duodenal switch group

Discussion Duodenal switch resulted in greater weight loss and better lipid profile than RYGB But, it is more difficult to perform laparoscopically and has a higher mortality rate More adverse events Health-related quality of life also seems to be similar after both surgeries Authors’ recs: Limit duodenal switch to the superobese who are likely to adhere to clinical follow-up Will need closer monitoring for micronutrient deficiencies

Questions?