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

2. 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

3. 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 kg/m2
Age years
Had not sustained previous wt loss

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

5. Duodenal Switch
200 cm
100 cm

6. Roux-en-Y vs. Duodenal Switch

7. Study Flow Diagram

8. Baseline Characteristics

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

10. 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

11. Adverse Events

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

13. 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

14. Questions?