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?