1 / 47

Bariatric Surgery and Metabolism

Bariatric Surgery and Metabolism. Goal: to review 4 important and clinically relevant papers from 2010 on Bariatric Surgery and Metabolism. 10/4/2014. 1. Disclosures. I am still pissed we’re not at Vail. Ethicon: Advisory board. Whistler 2004. Objective.

walden
Download Presentation

Bariatric Surgery and Metabolism

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Bariatric Surgery and Metabolism Goal: to review 4 important and clinically relevant papers from 2010 on Bariatric Surgery and Metabolism 10/4/2014 1

  2. Disclosures • I am still pissed we’re not at Vail. • Ethicon: Advisory board

  3. Whistler 2004

  4. Objective • Metabolic surgery to treat type 2 diabetes mellitus in patients who do not meet body weight criteria for morbid obesity (BMI 30-35) • Comparing LRYGB and LAGB in this patient population

  5. Methods • Bariatric Outcomes Longitudinal Database (BOLD) • 66264 bariatric procedures • 794 with BMI 30-35 kg/m2 • 235 with diabetes requiring medication • 109 LAGB ; 109 LRYGB • 92% Laparoscopic

  6. Results More severe DM in bypass group More complications in bypass group

  7. Results • Both procedures resulted in significant decrease in BMI, DM severity and # of DM medications • Gastric bypass showed better results than gastric band

  8. Results BMI # DM Meds.

  9. Results

  10. Conclusion • Both LAGB and LRYGB achieve significant, favorable impact on type 2 diabetes in the moderately obese (BMI 30-35) • Both procedures demonstrate a significant reduction in diabetes co-morbidity score and # of diabetes medication • Gastric bypass provides more effective treatment at the price of higher complication rates (mostly minor)

  11. Objective • Evaluation of bariatric surgery as secondary prevention in obese patients with ischemic heart disease (IHD)

  12. Methods • 4047 subjects in the Swedish Obese Subjects (SOS) group • 35 with IHD • 21 treated with bariatric surgery ; 14 treated conventionally • Mean follow-up 10.8 years

  13. Methods • SOS study:

  14. Results Mean weight change At 2 and 10 years bariatric surgery resulted in significantly greater weight loss compared to the control group

  15. Results

  16. Results

  17. Results

  18. Conclusion • Bariatric surgery appears to be a safe and feasible treatment to achieve long-term weight loss and improvement in cardio-vascular risk factors, symptoms and quality of life in obese subjects with IHD

  19. Objective • To present the longest follow-up report of any lipid-atherosclerosis interventional trial

  20. Methods • 25 years of follow-up in the POSCH study: Overall mortality Specific cause of death Prediction for increase in life expectancy

  21. Results

  22. Results

  23. Results

  24. Results

  25. Conclusion • A 25 year mortality follow-up in POSCH shows statistically significant gains in overall survival, cardio-vascular disease free survival and life expectancy in the surgery group compared to the controlled group

  26. Objective • To investigate the rate of type 2 diabetes remission after gastric bypass and banding and establish the mechanism leading to remission of type 2 diabetes after bariatric surgery

  27. Study 1: 34 obese type 2 diabetics Gastric bypass or banding 3 year follow-up Study 2 41 obese type 2 diabetics Gastric bypass, banding or very low calorie diet 42 day follow-up

  28. Results Study 1

  29. ResultsStudy 2

  30. ResultsStudy 2

  31. ResultsStudy 2

  32. Conclusion

  33. Methods • Trials comparing bariatric surgery vs. no surgery in patients with morbid obesity with the following end-points: • Non-CV mortality • CV mortality • Global mortality – CV + non-CV

  34. Results Small (<3000 pts.) vs. Large (>3000 pts.)

  35. Results LAGB Vs. RYGB

  36. Conclusion • Bariatric surgery reduces the risk of global mortality, CV mortality and all-cause mortality compared to participants not undergoing surgery • Risk reduction is lower in large studies than in small studies • Both gastric bypass and gastric band seem to reduce mortality risk

  37. Bariatric surgery and metabolism Other papers of interest

  38. 10/4/2014 43

  39. SUMMARY: Diabetes • Both restrictive (AGB) and malabsorptive (RGBP) procedures improve diabetic control • Improvement and remission of DM is significantly greater with malabsorptive (largely GBP), even with equivalent weight loss in some studies • Postprandial increase in GLP-1, insulin secretion and improvement in insulin resistance occurs only with GBP, even before weight loss; mechanisms (duodenal exclusion, incretin effects, neural, etc.) still incompletely explained • Restrictive and malabsorptive procedures both improve DM in patients with BMI <35, although less dramatically than in patients with BMI > 35

  40. SUMMARY: Mortality • Partial ileal bypass for hyperlipidemia improves 25 year survival, > in patients with baseline EF ≥ 50% (survival  by 1.7 years; 100,000 less deaths per million patients at 25 years) • Reduced mortality after both AGB and GBP compared to controls (global and all-cause) • ? Greater reduction in CV mortality with GBP reported in diabetics • Bariatric surgery can be performed safely in patients with IHD, but no reduction in CV events or deaths compared to controls (limitations of study: low BMI, small sample size, primarily restrictive procedures (VBG))

More Related