Skip to main content
Top

04-11-2024 | Sleeve Gastrectomy | Review

Efficacy of One Anastomosis Gastric Bypass Versus Sleeve Gastrectomy and Roux-en-Y Gastric Bypass for the Treatment of Type 2 Diabetes Mellitus: a Systematic Review and Meta-Analysis of Randomized Clinical Trials

Authors: Mohammad Kermansaravi, Sonja Chiappetta, Radwan Kassir, Alfonso Bosco, Xavier Giudicelli, Panagiotis Lainas, Maissa Safieddine

Published in: Obesity Surgery

Login to get access

Abstract

The worldwide prevalence of type 2 diabetes mellitus (T2DM) is increasing in parallel with obesity. One anastomosis gastric bypass (OAGB) is considered effective to treat both T2DM and obesity. The aim of this study was to evaluate the efficacy of OAGB versus sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) for treatment of T2DM, analyzing data exclusively from randomized control trials (RCTs). Α systematic review of published RCTs comparing OAGB versus RYGB or SG (control groups) in T2DM patients regarding diabetes remission and weight loss was performed. Primary endpoints were T2DM remission rate and 1-year and 5-year % weight loss postoperatively. Initial search identified 39 references, of which 8 RCTs were considered eligible for meta-analysis inclusion, comprising 636 patients (311 OAGB, 122 RYGB, 203 SG patients). Main meta-analysis findings were: i) higher 1-year %EWL for OAGB than control group (p = 0.04); ii) higher 5-year %EWL for OAGB than control group (p < 0.01); iii) no difference in 1-year remission rate of T2DM between OAGB and control group (p = 0.14); iv) 28% higher 5-year remission rate of T2DM for OAGB than control group (p < 0.01). OAGB had statistically significant better outcomes compared to RYGB and SG regarding T2DM remission and %EWL at 5 years. Further pathophysiologic studies are needed to indicate the most potent bariatric procedure in patients with T2DM and obesity.
Appendix
Available only for authorised users
Literature
1.
go back to reference Volaco A, Cavalcanti AM, Filho RP, et al. Socioeconomic status: the missing link between obesity and diabetes mellitus? Curr Diabetes Rev. 2018;14:321–6.PubMedCrossRef Volaco A, Cavalcanti AM, Filho RP, et al. Socioeconomic status: the missing link between obesity and diabetes mellitus? Curr Diabetes Rev. 2018;14:321–6.PubMedCrossRef
2.
go back to reference Kristensen FPB, Christensen DH, Callaghan BC, et al. The prevalence of polyneuropathy in type 2 diabetes subgroups based on HOMA2 indices of beta-cell function and insulin sensitivity. Diabetes Care. 2023;46:1546–55.PubMedCrossRef Kristensen FPB, Christensen DH, Callaghan BC, et al. The prevalence of polyneuropathy in type 2 diabetes subgroups based on HOMA2 indices of beta-cell function and insulin sensitivity. Diabetes Care. 2023;46:1546–55.PubMedCrossRef
3.
go back to reference Rubino F, Nathan DM, Eckel RH, et al. Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by International Diabetes Organizations. Diabetes Care. 2016;39:861–77.PubMedCrossRef Rubino F, Nathan DM, Eckel RH, et al. Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by International Diabetes Organizations. Diabetes Care. 2016;39:861–77.PubMedCrossRef
4.
go back to reference Hsu CC, Almulaifi A, Chen JC, et al. Effect of bariatric surgery vs medical treatment on type 2 diabetes in patients with body mass index lower than 35: five-year outcomes. JAMA Surg. 2015;150:1117–24.PubMedCrossRef Hsu CC, Almulaifi A, Chen JC, et al. Effect of bariatric surgery vs medical treatment on type 2 diabetes in patients with body mass index lower than 35: five-year outcomes. JAMA Surg. 2015;150:1117–24.PubMedCrossRef
5.
go back to reference Kenngott HG, Clemens G, Gondan M, et al. DiaSurg 2 trial–surgical vs. medical treatment of insulin-dependent type 2 diabetes mellitus in patients with a body mass index between 26 and 35 kg/m2: study protocol of a randomized controlled multicenter trial–DRKS00004550. Trials. 2013;14:183.PubMedPubMedCentralCrossRef Kenngott HG, Clemens G, Gondan M, et al. DiaSurg 2 trial–surgical vs. medical treatment of insulin-dependent type 2 diabetes mellitus in patients with a body mass index between 26 and 35 kg/m2: study protocol of a randomized controlled multicenter trial–DRKS00004550. Trials. 2013;14:183.PubMedPubMedCentralCrossRef
6.
go back to reference Ribaric G, Buchwald JN, McGlennon TW. Diabetes and weight in comparative studies of bariatric surgery vs conventional medical therapy: a systematic review and meta-analysis. Obes Surg. 2014;24:437–55.PubMedCrossRef Ribaric G, Buchwald JN, McGlennon TW. Diabetes and weight in comparative studies of bariatric surgery vs conventional medical therapy: a systematic review and meta-analysis. Obes Surg. 2014;24:437–55.PubMedCrossRef
7.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
8.
go back to reference Kermansaravi M, Parmar C, Chiappetta S, et al. Patient selection in one anastomosis/mini gastric bypass-an expert modified delphi consensus. Obes Surg. 2022;32:2512–24.PubMedCrossRef Kermansaravi M, Parmar C, Chiappetta S, et al. Patient selection in one anastomosis/mini gastric bypass-an expert modified delphi consensus. Obes Surg. 2022;32:2512–24.PubMedCrossRef
9.
go back to reference Shivakumar S, Tantia O, Goyal G, et al. LSG vs MGB-OAGB-3 year follow-up data: a randomised control trial. Obes Surg. 2018;28:2820–8.PubMedCrossRef Shivakumar S, Tantia O, Goyal G, et al. LSG vs MGB-OAGB-3 year follow-up data: a randomised control trial. Obes Surg. 2018;28:2820–8.PubMedCrossRef
10.
go back to reference Abu-Abeid A, Lessing Y, Pencovich N, et al. Diabetes resolution after one anastomosis gastric bypass. Surg Obes Relat Dis. 2018;14:181–5.PubMedCrossRef Abu-Abeid A, Lessing Y, Pencovich N, et al. Diabetes resolution after one anastomosis gastric bypass. Surg Obes Relat Dis. 2018;14:181–5.PubMedCrossRef
11.
go back to reference Singh B, Saikaustubh Y, Singla V, et al. One Anastomosis Gastric Bypass (OAGB) vs Roux en Y Gastric Bypass (RYGB) for remission of T2DM in patients with morbid obesity: a randomized controlled trial. Obes Surg. 2023;33:1218–27.PubMedCrossRef Singh B, Saikaustubh Y, Singla V, et al. One Anastomosis Gastric Bypass (OAGB) vs Roux en Y Gastric Bypass (RYGB) for remission of T2DM in patients with morbid obesity: a randomized controlled trial. Obes Surg. 2023;33:1218–27.PubMedCrossRef
12.
go back to reference Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Int J Surg. 2021;88: 105906.PubMedCrossRef Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Int J Surg. 2021;88: 105906.PubMedCrossRef
13.
go back to reference Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;358: j4008.PubMedPubMedCentralCrossRef Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;358: j4008.PubMedPubMedCentralCrossRef
14.
go back to reference Sterne JAC, Savovic J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366: l4898.PubMedCrossRef Sterne JAC, Savovic J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366: l4898.PubMedCrossRef
16.
go back to reference Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539–58.PubMedCrossRef Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539–58.PubMedCrossRef
17.
go back to reference Sterne JA, Sutton AJ, Ioannidis JP, et al. Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ. 2011;343: d4002.PubMedCrossRef Sterne JA, Sutton AJ, Ioannidis JP, et al. Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ. 2011;343: d4002.PubMedCrossRef
18.
go back to reference Seetharamaiah S, Tantia O, Goyal G, et al. LSG vs OAGB-1 year follow-up data-a randomized control trial. Obes Surg. 2017;27:948–54.PubMedCrossRef Seetharamaiah S, Tantia O, Goyal G, et al. LSG vs OAGB-1 year follow-up data-a randomized control trial. Obes Surg. 2017;27:948–54.PubMedCrossRef
19.
go back to reference Level L, Rojas A, Pinango S, et al. One anastomosis gastric bypass vs. Roux-en-Y gastric bypass: a 5-year follow-up prospective randomized trial. Langenbecks Arch Surg. 2021;406:171–9.PubMedCrossRef Level L, Rojas A, Pinango S, et al. One anastomosis gastric bypass vs. Roux-en-Y gastric bypass: a 5-year follow-up prospective randomized trial. Langenbecks Arch Surg. 2021;406:171–9.PubMedCrossRef
20.
go back to reference Lee WJ, Chong K, Ser KH, et al. Gastric bypass vs sleeve gastrectomy for type 2 diabetes mellitus: a randomized controlled trial. Arch Surg. 2011;146:143–8.PubMedCrossRef Lee WJ, Chong K, Ser KH, et al. Gastric bypass vs sleeve gastrectomy for type 2 diabetes mellitus: a randomized controlled trial. Arch Surg. 2011;146:143–8.PubMedCrossRef
21.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
22.
go back to reference Jain M, Tantia O, Goyal G, et al. LSG vs MGB-OAGB: 5-year follow-up data and comparative outcome of the two procedures over long term-results of a randomised control trial. Obes Surg. 2021;31:1223–32.PubMedCrossRef Jain M, Tantia O, Goyal G, et al. LSG vs MGB-OAGB: 5-year follow-up data and comparative outcome of the two procedures over long term-results of a randomised control trial. Obes Surg. 2021;31:1223–32.PubMedCrossRef
23.
go back to reference Robert M, Espalieu P, Pelascini E, et al. Efficacy and safety of one anastomosis gastric bypass versus Roux-en-Y gastric bypass for obesity (YOMEGA): a multicentre, randomised, open-label, non-inferiority trial. Lancet. 2019;393:1299–309.PubMedCrossRef Robert M, Espalieu P, Pelascini E, et al. Efficacy and safety of one anastomosis gastric bypass versus Roux-en-Y gastric bypass for obesity (YOMEGA): a multicentre, randomised, open-label, non-inferiority trial. Lancet. 2019;393:1299–309.PubMedCrossRef
24.
go back to reference Pu YD, Li JQ, Cao ZY, et al. Clinical observation of gastric bypass in treatment of type 2 diabetes. Chin Med J (Engl). 2012;125:1899–902.PubMed Pu YD, Li JQ, Cao ZY, et al. Clinical observation of gastric bypass in treatment of type 2 diabetes. Chin Med J (Engl). 2012;125:1899–902.PubMed
25.
go back to reference Saeedi P, Petersohn I, Salpea P, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the International Diabetes Federation Diabetes Atlas, 9(th) edition. Diabetes Res Clin Pract. 2019;157: 107843.PubMedCrossRef Saeedi P, Petersohn I, Salpea P, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the International Diabetes Federation Diabetes Atlas, 9(th) edition. Diabetes Res Clin Pract. 2019;157: 107843.PubMedCrossRef
26.
go back to reference Group GSR, Nathan DM, Lachin JM, et al. Glycemia reduction in type 2 diabetes - microvascular and cardiovascular outcomes. N Engl J Med. 2022;387:1075–88.CrossRef Group GSR, Nathan DM, Lachin JM, et al. Glycemia reduction in type 2 diabetes - microvascular and cardiovascular outcomes. N Engl J Med. 2022;387:1075–88.CrossRef
27.
go back to reference Mingrone G, Panunzi S, De Gaetano A, et al. Metabolic surgery versus conventional medical therapy in patients with type 2 diabetes: 10-year follow-up of an open-label, single-centre, randomised controlled trial. Lancet. 2021;397:293–304.PubMedCrossRef Mingrone G, Panunzi S, De Gaetano A, et al. Metabolic surgery versus conventional medical therapy in patients with type 2 diabetes: 10-year follow-up of an open-label, single-centre, randomised controlled trial. Lancet. 2021;397:293–304.PubMedCrossRef
28.
go back to reference De Luca M, Zese M, Bandini G, et al. Metabolic bariatric surgery as a therapeutic option for patients with type 2 diabetes: a meta-analysis and network meta-analysis of randomized controlled trials. Diabetes Obes Metab. 2023;25:2362–73.PubMedCrossRef De Luca M, Zese M, Bandini G, et al. Metabolic bariatric surgery as a therapeutic option for patients with type 2 diabetes: a meta-analysis and network meta-analysis of randomized controlled trials. Diabetes Obes Metab. 2023;25:2362–73.PubMedCrossRef
29.
go back to reference 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.PubMedPubMedCentralCrossRef 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.PubMedPubMedCentralCrossRef
30.
go back to reference De Luca M, Piatto G, Merola G, et al. IFSO update position statement on One Anastomosis Gastric Bypass (OAGB). Obes Surg. 2021;31:3251–78.PubMedCrossRef De Luca M, Piatto G, Merola G, et al. IFSO update position statement on One Anastomosis Gastric Bypass (OAGB). Obes Surg. 2021;31:3251–78.PubMedCrossRef
31.
go back to reference Taha O, Abdelaal M, Abozeid M, et al. Outcomes of one anastomosis gastric bypass in 472 diabetic patients. Obes Surg. 2017;27:2802–10.PubMedCrossRef Taha O, Abdelaal M, Abozeid M, et al. Outcomes of one anastomosis gastric bypass in 472 diabetic patients. Obes Surg. 2017;27:2802–10.PubMedCrossRef
32.
go back to reference Bettini S, Segato G, Prevedello L, et al. Improvement of lipid profile after one-anastomosis gastric bypass compared to sleeve gastrectomy. Nutrients. 2021;13:2770–80.PubMedPubMedCentralCrossRef Bettini S, Segato G, Prevedello L, et al. Improvement of lipid profile after one-anastomosis gastric bypass compared to sleeve gastrectomy. Nutrients. 2021;13:2770–80.PubMedPubMedCentralCrossRef
33.
go back to reference Salminen P, Gronroos S, Helmio M, et al. Effect of laparoscopic sleeve gastrectomy vs Roux-en-Y gastric bypass on weight loss, comorbidities, and reflux at 10 years in adult patients with obesity: the SLEEVEPASS randomized clinical trial. JAMA Surg. 2022;157:656–66.PubMedPubMedCentralCrossRef Salminen P, Gronroos S, Helmio M, et al. Effect of laparoscopic sleeve gastrectomy vs Roux-en-Y gastric bypass on weight loss, comorbidities, and reflux at 10 years in adult patients with obesity: the SLEEVEPASS randomized clinical trial. JAMA Surg. 2022;157:656–66.PubMedPubMedCentralCrossRef
34.
go back to reference Riddle MC, Cefalu WT, Evans PH, et al. Consensus report: definition and interpretation of remission in type 2 diabetes. Diabetes Care. 2021;44:2438–44.PubMedPubMedCentralCrossRef Riddle MC, Cefalu WT, Evans PH, et al. Consensus report: definition and interpretation of remission in type 2 diabetes. Diabetes Care. 2021;44:2438–44.PubMedPubMedCentralCrossRef
35.
go back to reference Habegger KM, Al-Massadi O, Heppner KM, et al. Duodenal nutrient exclusion improves metabolic syndrome and stimulates villus hyperplasia. Gut. 2014;63:1238–46.PubMedCrossRef Habegger KM, Al-Massadi O, Heppner KM, et al. Duodenal nutrient exclusion improves metabolic syndrome and stimulates villus hyperplasia. Gut. 2014;63:1238–46.PubMedCrossRef
36.
go back to reference Fineman MS, Bryant CLN, Colbert K, et al. First-in-human study of a pharmacological duodenal exclusion therapy shows reduced postprandial glucose and insulin and increased bile acid and gut hormone concentrations. Diabetes Obes Metab. 2023;25:2447–56.PubMedCrossRef Fineman MS, Bryant CLN, Colbert K, et al. First-in-human study of a pharmacological duodenal exclusion therapy shows reduced postprandial glucose and insulin and increased bile acid and gut hormone concentrations. Diabetes Obes Metab. 2023;25:2447–56.PubMedCrossRef
37.
go back to reference Cummings BP. Duodenal exclusion devices: promising tools in treating obesity and type 2 diabetes. Gut. 2014;63:1201–2.PubMedCrossRef Cummings BP. Duodenal exclusion devices: promising tools in treating obesity and type 2 diabetes. Gut. 2014;63:1201–2.PubMedCrossRef
38.
go back to reference Salman MA, Salman A, Assal MM, et al. One Anastomosis Gastric Bypass (OAGB) with a 150-cm Biliopancreatic Limb (BPL) versus a 200-cm BPL, a systematic review and meta-analysis. Obes Surg. 2023;33:1846–56.PubMedPubMedCentralCrossRef Salman MA, Salman A, Assal MM, et al. One Anastomosis Gastric Bypass (OAGB) with a 150-cm Biliopancreatic Limb (BPL) versus a 200-cm BPL, a systematic review and meta-analysis. Obes Surg. 2023;33:1846–56.PubMedPubMedCentralCrossRef
39.
go back to reference Cavin JB, Couvelard A, Lebtahi R, et al. Differences in alimentary glucose absorption and intestinal disposal of blood glucose after Roux-en-Y gastric bypass vs sleeve gastrectomy. Gastroenterology. 2016;150(454–64): e9. Cavin JB, Couvelard A, Lebtahi R, et al. Differences in alimentary glucose absorption and intestinal disposal of blood glucose after Roux-en-Y gastric bypass vs sleeve gastrectomy. Gastroenterology. 2016;150(454–64): e9.
40.
go back to reference Bruinsma FFE, Nienhuijs SW, Liem RSL, et al. The impact of longer biliopancreatic limb length on weight loss and comorbidity improvement at 5 years after primary Roux-en-Y gastric bypass surgery: a population-based matched cohort study. Obes Surg. 2024;34:3236–45.PubMedPubMedCentralCrossRef Bruinsma FFE, Nienhuijs SW, Liem RSL, et al. The impact of longer biliopancreatic limb length on weight loss and comorbidity improvement at 5 years after primary Roux-en-Y gastric bypass surgery: a population-based matched cohort study. Obes Surg. 2024;34:3236–45.PubMedPubMedCentralCrossRef
41.
go back to reference Salman MA, Abelsalam A, Nashed GA, et al. Long biliopancreatic limb Roux-En-Y gastric bypass versus one-anastomosis gastric bypass: a randomized controlled study. Obes Surg. 2023;33:1966–73.PubMedPubMedCentralCrossRef Salman MA, Abelsalam A, Nashed GA, et al. Long biliopancreatic limb Roux-En-Y gastric bypass versus one-anastomosis gastric bypass: a randomized controlled study. Obes Surg. 2023;33:1966–73.PubMedPubMedCentralCrossRef
43.
go back to reference Mantziari S, Abboretti F, Favre L, et al. Protein malnutrition after Roux-en-Y gastric bypass: a challenging case and scoping review of the literature. Surg Obes Relat Dis. 2023;19:746–54.PubMedCrossRef Mantziari S, Abboretti F, Favre L, et al. Protein malnutrition after Roux-en-Y gastric bypass: a challenging case and scoping review of the literature. Surg Obes Relat Dis. 2023;19:746–54.PubMedCrossRef
44.
go back to reference Pucher PH, Lord AC, Sodergren MH, et al. Reversal to normal anatomy after failed gastric bypass: systematic review of indications, techniques, and outcomes. Surg Obes Relat Dis. 2016;12:1351–6.PubMedCrossRef Pucher PH, Lord AC, Sodergren MH, et al. Reversal to normal anatomy after failed gastric bypass: systematic review of indications, techniques, and outcomes. Surg Obes Relat Dis. 2016;12:1351–6.PubMedCrossRef
Metadata
Title
Efficacy of One Anastomosis Gastric Bypass Versus Sleeve Gastrectomy and Roux-en-Y Gastric Bypass for the Treatment of Type 2 Diabetes Mellitus: a Systematic Review and Meta-Analysis of Randomized Clinical Trials
Authors
Mohammad Kermansaravi
Sonja Chiappetta
Radwan Kassir
Alfonso Bosco
Xavier Giudicelli
Panagiotis Lainas
Maissa Safieddine
Publication date
04-11-2024
Publisher
Springer US
Published in
Obesity Surgery
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-024-07564-z
SPONSORED

Mastering chronic pancreatitis pain: A multidisciplinary approach and practical solutions

  • Webinar | 06-02-2024 | 20:00 (CET)

Severe pain is the most common symptom of chronic pancreatitis. In this webinar, experts share the latest insights in pain management for chronic pancreatitis patients. Experts from a range of disciplines discuss pertinent cases and provide practical suggestions for use within clinical practice.

Sponsored by:
  • Viatris
Developed by: Springer Healthcare
Watch now