Research: SOVIK and COLLEAGUES,

Listed in Issue 194

Abstract

SOVIK and COLLEAGUES, Oslo University Hospital Aker, University of Oslo, Norway. t.t.sovik@medisin.uio.no sought to determine whether duodenal switch leads to greater weight loss and more favourable improvements in cardiovascular risk factors and quality of life than gastric bypass.

Background

Gastric bypass and duodenal switch are currently performed bariatric surgical procedures. Uncontrolled studies suggest that duodenal switch induces greater weight loss than gastric bypass.

Methodology

Randomized, parallel-group trial. (ClinicalTrials.gov registration number: NCT00327912) Setting 2 academic medical centres (1 in Norway and 1 in Sweden). 60 participants with a body mass index (BMI) between 50 and 60 kg/m(2). Intervention: Gastric bypass (n = 31) or duodenal switch (n = 29). The primary outcome was the change in BMI after 2 years. Secondary outcomes included anthropometric measures; concentrations of blood lipids, glucose, insulin, C-reactive protein, and vitamins; and health-related quality of life and adverse events.

Results

Fifty-eight of 60 participants (97%) completed the study. The mean reductions in BMI were 17.3 kg/m(2) (95% CI, 15.7 to 19.0 kg/m(2)) after gastric bypass and 24.8 kg/m(2) (CI, 23.0 to 26.5 kg/m(2)) after duodenal switch (mean between-group difference, 7.44 kg/m(2) [CI, 5.24 to 9.64 kg/m(2)]; P < 0.001). Total cholesterol concentration decreased by 0.24 mmol/L (CI, -0.03 to 0.50 mmol/L) (9.27 mg/dL [CI, -1.16 to 19.3 mg/dL]) after gastric bypass and 1.07 mmol/L (CI, 0.79 to 1.35 mmol/L) (41.3 mg/dL [CI, 30.5 to 52.1 mg/dL]) after duodenal switch (mean between-group difference, 0.83 mmol/L [CI, 0.48 to 1.18 mmol/L]; 32.0 mg/dL [CI, 18.5 to 45.6 mg/dL]; P <= 0.001). Reductions in low-density lipoprotein cholesterol concentration, anthropometric measures, fat mass, and fat-free mass were also greater after duodenal switch (P <= 0.010 for each between-group comparison). Both groups had reductions in blood pressure and mean concentrations of glucose, insulin, and C-reactive protein, with no between-group differences. The duodenal switch group, but not the gastric bypass group, had reductions in concentrations of vitamin A and 25-hydroxyvitamin D. Most Short Form-36 Health Survey dimensional scores improved in both groups, with greater improvement in 1 of 8 domains (bodily pain) after gastric bypass. From surgery until 2 years, 10 participants (32%) had adverse events after gastric bypass and 18 (62%) after duodenal switch (P = 0.021). Adverse events related to malnutrition occurred only after duodenal switch.

Conclusion

Clinical experience was greater with gastric bypass than with duodenal switch at the study centres. Duodenal switch surgery was associated with greater weight loss, greater reductions of total and low-density lipoprotein cholesterol concentrations, and more adverse events. Improvements in other cardiovascular risk factors and quality of life were similar after both procedures.

References

PRIMARY FUNDING SOURCE: South-Eastern Norway Regional Health Authority.
Sovik TT, Aasheim ET, Taha O, Engstrom M, Fagerland MW, Bjorkman S, Kristinsson J, Birkeland KI, Mala T and Olbers T. Weight loss, cardiovascular risk factors, and quality of life after gastric bypass and duodenal switch: a randomized trial.[Summary for patients in Ann Intern Med. 2011 Sep 6;155(5):I21; PMID: 21893617] Comment in: Ann Intern Med. 2011 Sep 6;155(5):329-30; PMID: 21893627 Source Annals of Internal Medicine. 155(5):281-91, Sep 6 2011.

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