Top

Published in:

01-09-2021 | Sleeve Gastrectomy | Original Contributions

The Choice of Gastric Bypass or Sleeve Gastrectomy for Patients Stratified by Diabetes Duration and Body Mass Index (BMI) level: Results from a National Registry and Meta-analysis

Authors: Mengyi Li, Na Zeng, Yang Liu, Wenmao Yan, Songhai Zhang, Liangping Wu, Shaozhuang Liu, Jun Wang, Xiangwen Zhao, Jianli Han, Jiansheng Kang, Nengwei Zhang, Peng Zhang, Rixing Bai, Zhongtao Zhang, for the Greater China Metabolic and Bariatric Surgery Database (GC-MBD) study group

Published in: Obesity Surgery | Issue 9/2021

Abstract

Purpose

To determine whether sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) should be the optimal choice in patients stratified by diabetes duration and body mass index (BMI) level.

Methods

Classification tree analysis was performed to identify the influential factors for surgical procedure selection in real setting. Meta-analyses stratified by influential factors were conducted to compare the complete diabetes remission rates between SG and RYGB. The cost-effectiveness analysis was performed when results from meta-analysis remain uncertain.

Results

Among 3198 bariatric procedures in China, 824 (73%) SGs and 191 (17%) RYGBs were performed in patients with T2DM. Diabetes duration with a cutoff value of 5 years and BMI level with 35.5 kg/m² were identified as the influential factors. For patients with diabetes duration > 5 years, RYGB showed a significant higher complete diabetes remission rate than SG at 1 year: 0.52 (95% confidence interval (CI): 0.46–0.58) versus 0.36 (95% CI: 0.30–0.42). For patients with diabetes duration ≤ 5 years and BMI ≥ 35.5 kg/m², there was no significant difference between 2 procedures: 0.57 (95% CI: 0.43–0.71) for SG versus 0.66 (95% CI: 0.62–0.70) for RYGB. The cost-effectiveness ratios of SG and RYGB were 244.58 and 276.97 dollars per QALY, respectively.

Conclusions

For patients with diabetes duration > 5 years, RYGB was the optimal choice with regard to achieving complete diabetes remission at 1 year after surgery. However, for patients with diabetes duration ≤ 5 years and BMI ≥ 35.5 kg/m², SG appeared to provide a cost-effective choice.

Graphical abstract

Rubino F, Kaplan LM, Schauer PR, et al. The Diabetes Surgery Summit consensus conference: recommendations for the evaluation and use of gastrointestinal surgery to treat type 2 diabetes mellitus. Ann Surg. 2010;251:399–405. https://doi.org/10.1097/SLA.0b013e3181be34e7.CrossRefPubMed

Hedenbro JL, Näslund E, Boman L, et al. Formation of the Scandinavian obesity surgery registry, SOReg. Obes Surg. 2015;25:1893–900. https://doi.org/10.1007/s11695-015-1619-5.CrossRefPubMed

Hopkins J, Welbourn R. The importance of national registries/databases in metabolic surgery: the UK experience. Surg Obes Relat Dis. 2016;12:1178–85. https://doi.org/10.1016/j.soard.2016.02.030.CrossRefPubMed

Welbourn R, Hollyman M, Kinsman R, et al. Bariatric surgery worldwide: baseline demographic description and one-year outcomes from the Fourth IFSO Global Registry Report 2018. Obes Surg. 2019;29:782–95. https://doi.org/10.1007/s11695-018-3593-1.CrossRefPubMed

DeMaria EJ, Pate V, Warthen M, et al. Baseline data from American Society for Metabolic and Bariatric Surgery-designated Bariatric Surgery Centers of Excellence using the Bariatric Outcomes Longitudinal Database. Surg Obes Relat Dis. 2010;6:347–55. https://doi.org/10.1016/j.soard.2009.11.015.CrossRefPubMed

Lazzati A, Guy-Lachuer R, Delaunay V, et al. Bariatric surgery trends in France: 2005-2011. Surg Obes Relat Dis. 2014;10:328–34. https://doi.org/10.1016/j.soard.2013.07.015.CrossRefPubMed

Poelemeijer YQM, Liem RSL, Våge V, et al. Gastric bypass versus sleeve gastrectomy: patient selection and short-term outcome of 47,101 primary operations from the Swedish, Norwegian, and Dutch national quality registries. Ann Surg. 2019;272:326–33. https://doi.org/10.1097/sla.0000000000003279.CrossRef

El Chaar M, Stoltzfus J, Gersin K, et al. A novel risk prediction model for 30-day severe adverse events and readmissions following bariatric surgery based on the MBSAQIP database. Surg Obes Relat Dis. 2019;15:1138–45. https://doi.org/10.1016/j.soard.2019.03.005.CrossRefPubMed

Clapp B, Hahn J, Dodoo C, et al. Evaluation of the rate of marginal ulcer formation after bariatric surgery using the MBSAQIP database. Surg Endosc. 2019;33:1890–7. https://doi.org/10.1007/s00464-018-6468-6.CrossRefPubMed

10.

Mocanu V, Dang J, Ladak F, et al. Predictors and outcomes of bleed after sleeve gastrectomy: an analysis of the MBSAQIP data registry. Surg Obes Relat Dis. 2019;15:1675–81. https://doi.org/10.1016/j.soard.2019.07.017.CrossRefPubMed

11.

Mocanu V, Dang J, Ladak F, et al. Predictors and outcomes of leak after Roux-en-Y gastric bypass: an analysis of the MBSAQIP data registry. Surg Obes Relat Dis. 2019;15:396–403. https://doi.org/10.1016/j.soard.2019.01.012.CrossRefPubMed

12.

Ibrahim AM, Ghaferi AA, Thumma JR, et al. Variation in outcomes at bariatric surgery centers of excellence. JAMA Surg. 2017;152:629–36. https://doi.org/10.1001/jamasurg.2017.0542.CrossRefPubMedPubMedCentral

13.

Berger ER, Clements RH, Morton JM, et al. The impact of different surgical techniques on outcomes in laparoscopic sleeve gastrectomies: the first report from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). Ann Surg. 2016;264:464–73. https://doi.org/10.1097/sla.0000000000001851.CrossRefPubMed

14.

Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366:1567–76. https://doi.org/10.1056/NEJMoa1200225.CrossRefPubMedPubMedCentral

15.

Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes--3-year outcomes. N Engl J Med. 2014;370:2002–13. https://doi.org/10.1056/NEJMoa1401329.CrossRefPubMedPubMedCentral

16.

Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes - 5-year outcomes. N Engl J Med. 2017;376:641–51. https://doi.org/10.1056/NEJMoa1600869.CrossRefPubMedPubMedCentral

17.

Keidar A, Hershkop KJ, Marko L, et al. Roux-en-Y gastric bypass vs sleeve gastrectomy for obese patients with type 2 diabetes: a randomised trial. Diabetologia. 2013;56:1914–8. https://doi.org/10.1007/s00125-013-2965-2.CrossRefPubMed

18.

Yang J, Wang C, Cao G, et al. Long-term effects of laparoscopic sleeve gastrectomy versus roux-en-Y gastric bypass for the treatment of Chinese type 2 diabetes mellitus patients with body mass index 28-35 kg/m(2). BMC Surg. 2015;15:88. https://doi.org/10.1186/s12893-015-0074-5.CrossRefPubMedPubMedCentral

19.

Tang Q, Sun Z, Zhang N, et al. Cost-effectiveness of bariatric surgery for type 2 diabetes mellitus: a randomized controlled trial in China. Medicine. 2016;95:e3522. https://doi.org/10.1097/md.0000000000003522.CrossRefPubMedPubMedCentral

20.

Murphy R, Clarke MG, Evennett NJ, et al. Laparoscopic sleeve gastrectomy versus banded Roux-en-Y gastric bypass for diabetes and obesity: a prospective randomised double-blind trial. Obes Surg. 2018;28:293–302. https://doi.org/10.1007/s11695-017-2872-6.CrossRefPubMed

21.

Hofsø D, Fatima F, Borgeraas H, et al. Gastric bypass versus sleeve gastrectomy in patients with type 2 diabetes (Oseberg): a single-centre, triple-blind, randomised controlled trial. Lancet Diabetes Endocrinol. 2019;7:912–24. https://doi.org/10.1016/s2213-8587(19)30344-4.CrossRefPubMed

22.

Consultation WHOE. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363:157–63. https://doi.org/10.1016/S0140-6736(03)15268-3.CrossRef

23.

Wan B, Fang N, Guan W, et al. Cost-effectiveness of bariatric surgery versus medication therapy for obese patients with type 2 diabetes in China: A Markov Analysis. J Diabetes Res. 2019;2019:1341963–11. https://doi.org/10.1155/2019/1341963.CrossRefPubMedPubMedCentral

24.

Lee WJ, Chong K, Lin YH, et al. Laparoscopic sleeve gastrectomy versus single anastomosis (mini-) gastric bypass for the treatment of type 2 diabetes mellitus: 5-year results of a randomized trial and study of incretin effect. Obes Surg. 2014;24:1552–62. https://doi.org/10.1007/s11695-014-1344-5.CrossRefPubMed

25.

Wallenius V et al. Sleeve gastrectomy and Roux-en-Y gastric bypass in the treatment of type 2 diabetes. Two-year results from a Swedish multicenter randomized controlled trial. Surg Obes Relat Dis. 2020; https://doi.org/10.1016/j.soard.2020.04.033.

26.

Casajoana A, Pujol J, Garcia A, et al. Predictive value of gut peptides in T2D remission: randomized controlled trial comparing metabolic gastric bypass, sleeve gastrectomy and greater curvature plication. Obes Surg. 2017;27:2235–45. https://doi.org/10.1007/s11695-017-2669-7.CrossRefPubMed

27.

Zhang HW et al. Is Roux-en-Y gastric bypass advantageous?—surgical outcomes in obese patients with type-2 diabetes after gastric bypass versus sleeve gastrectomy, a matched retrospective study. Ann Transl Med. 2020;8 https://doi.org/10.21037/atm.2020.02.08.

28.

Bhasker AG, Dixon JB, Lakdawala M. Selection of bypass vs sleeve for the management of type-2 diabetes in severely obese: could ethnicity play a role? Obes Surg. 2018;28:3073–9. https://doi.org/10.1007/s11695-018-3294-9.CrossRefPubMed

29.

Bruno G, Gruden G, Barutta F, et al. What is the impact of sleeve gastrectomy and gastric bypass on metabolic control of diabetes? A clinic-based cohort of Mediterranean diabetic patients. Surg Obes Relat Dis. 2015;11:1014–9. https://doi.org/10.1016/j.soard.2015.02.017.CrossRefPubMed

30.

Lee WJ, Chong K, Aung L, et al. Metabolic surgery for diabetes treatment: sleeve gastrectomy or gastric bypass? World J Surg. 2017;41:216–23. https://doi.org/10.1007/s00268-016-3690-z.CrossRefPubMed

31.

Dang JT, Sheppard C, Kim D, et al. Predictive factors for diabetes remission after bariatric surgery. Can J Surg J. 2019;62:315–9.CrossRef

32.

Zhang R, Borisenko O, Telegina I, et al. Systematic review of risk prediction models for diabetes after bariatric surgery. Br J Surg. 2016;103:1420–7. https://doi.org/10.1002/bjs.10255.CrossRefPubMed

33.

Lee WJ, Hur KY, Lakadawala M, et al. Predicting success of metabolic surgery: age, body mass index, C-peptide, and duration score. Surg Obes Relat Dis. 2013;9:379–84. https://doi.org/10.1016/j.soard.2012.07.015.CrossRefPubMed

34.

Aminian A, Brethauer SA, Andalib A, et al. Individualized metabolic surgery score: procedure selection based on diabetes severity. Ann Surg. 2017;266:650–7. https://doi.org/10.1097/sla.0000000000002407.CrossRefPubMed

35.

Still CD, Wood GC, Benotti P, et al. Preoperative prediction of type 2 diabetes remission after Roux-en-Y gastric bypass surgery: a retrospective cohort study. Lancet Diabetes Endocrinol. 2014;2:38–45. https://doi.org/10.1016/s2213-8587(13)70070-6.CrossRefPubMedPubMedCentral

36.

Jans A, Näslund I, Ottosson J, et al. Duration of type 2 diabetes and remission rates after bariatric surgery in Sweden 2007-2015: a registry-based cohort study. PLoS Med. 2019;16:e1002985. https://doi.org/10.1371/journal.pmed.1002985.CrossRefPubMedPubMedCentral

37.

Zoungas S et al. Impact of age, age at diagnosis and duration of diabetes on the risk of macrovascular and microvascular complications and death in type 2 diabetes. Diabetologia. 2014;57:2465–74. https://doi.org/10.1007/s00125-014-3369-7.CrossRefPubMed

38.

Batterham RL, Cummings DE. Mechanisms of diabetes improvement following bariatric/metabolic surgery. Diabetes Care. 2016;39:893–901. https://doi.org/10.2337/dc16-0145.CrossRefPubMedPubMedCentral

39.

Borgeraas H, Hofsø D, Hertel JK, et al. Comparison of the effect of Roux-en-Y gastric bypass and sleeve gastrectomy on remission of type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. Obes Rev. 2020;21:e13011. https://doi.org/10.1111/obr.13011.CrossRefPubMedPubMedCentral

40.

Lee Y, Doumouras AG, Yu J, et al. Laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass: a systematic review and meta-analysis of weight loss, comorbidities, and biochemical outcomes from randomized controlled trials. Ann Surg. 2019;273:66–74. https://doi.org/10.1097/sla.0000000000003671.CrossRef

Title: The Choice of Gastric Bypass or Sleeve Gastrectomy for Patients Stratified by Diabetes Duration and Body Mass Index (BMI) level: Results from a National Registry and Meta-analysis
Authors: Mengyi Li
Na Zeng
Yang Liu
Wenmao Yan
Songhai Zhang
Liangping Wu
Shaozhuang Liu
Jun Wang
Xiangwen Zhao
Jianli Han
Jiansheng Kang
Nengwei Zhang
Peng Zhang
Rixing Bai
Zhongtao Zhang
for the Greater China Metabolic and Bariatric Surgery Database (GC-MBD) study group
Publication date: 01-09-2021
Publisher: Springer US
Keywords: Sleeve Gastrectomy
Bariatric Surgery
Bariatric Surgery
Published in: Obesity Surgery / Issue 9/2021
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-021-05459-x

At a glance: The STEP trials

Springer Medicine

The Choice of Gastric Bypass or Sleeve Gastrectomy for Patients Stratified by Diabetes Duration and Body Mass Index (BMI) level: Results from a National Registry and Meta-analysis

Abstract

Purpose

Methods

Results

Conclusions

Graphical abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Graphical abstract

Please log in to get access to this content

Other articles of this Issue 9/2021

Differential Behavior of 25(OH)D and f25(OH)D3 in Patients with Morbid Obesity After Bariatric Surgery

Initial Experience with Alternate-Day Liraglutide for Weight Regain Following Bariatric Surgery

BMI Course Over 10 Years After Bariatric Surgery and Biopsychosocial Complexity Assessed with the INTERMED: a Retrospective Study

Indications and Outcomes of Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass: a Systematic Review and a Meta-analysis

Impact of Bariatric Surgery on Male Sexual Health: a Prospective Study

The Effect of Helicobacter pylori Eradication on Gastric Wall Thickness in Patients Undergoing Laparoscopic Sleeve Gastrectomy