CHICAGO — The duodenal switch procedure resolved comorbidities in “super-obese” patients more effectively than does Roux-en-Y gastric bypass, according to ongoing follow-up of a single-institution case series presented at the annual Digestive Disease Week.
Dr. Vivek N. Prachand of the University of Chicago presented data on 350 patients with a BMI of more than 50 kg/m
The super-obese category—those with a BMI of more than 50 and who are at least 200 pounds above ideal body weight—is the fastest-growing obesity group, said Dr. Prachand in a press briefing. Roux-en-Y gastric bypass is performed more often in this group, but in an earlier study of this same patient cohort, Dr. Prachand and his colleagues showed that gastric bypass does not always achieve the greatest weight loss.
Duodenal switch accounts for less than 10% of procedures in the super-obese group, he said, noting that it is technically more difficult and generally results in a greater degree of malabsorption.
In this study, 198 patients underwent duodenal switch and 152 had gastric bypass. At baseline, the incidence and severity of hypertension, dyslipidemia, and gastroesophageal reflux disease (GERD) were similar in the two groups. Diabetes was less common but more severe in the duodenal switch group, affecting 24% (47 patients), compared with 35% (53 patients) in the gastric bypass group.
At 36 months after surgery, all of the duodenal switch patients had a resolution of diabetes, which meant they were no longer using insulin and their blood sugar had returned to normal levels, compared with 91 patients (60%) of the bypass group.
A total of 70% (138) of the duodenal switch group had a resolution of hypertension, compared with only 39% (59) of the gastric bypass arm. Lipid levels returned to normal for 72% (142) of the duodenal switch patients, compared with only 26% (39) of the gastric bypass group.
GERD resolved in a greater proportion of the bypass group, which makes sense anatomically, said Dr. Prachand. The percentage with resolution of GERD was 77% (117) in the gastric bypass group, versus 49% (97) of the duodenal switch group.
The amount of weight lost did not seem to be correlated with the resolution of comorbidities, said Dr. Prachand. “It raises some very interesting avenues for investigation in terms of trying to understand the mechanisms of these underlying diseases as well as how these diseases improve with these operations,” he said.
It's still not clear which procedure is of greatest benefit to which obesity patients, said Dr. Prachand. When choosing a procedure for his patients, he considers three factors: the severity of the obesity; the associated medical problems, as some procedures might be better than others for resolving metabolic issues; and patient preference, because the procedures require motivation and follow-up, he said.
Dr. Prachand reported no conflicts of interest.