medwireNews: Patients undergoing Roux-en-Y gastric bypass experience significantly greater weight loss for at least 5 years than those undergoing sleeve gastrectomy and adjustable gastric banding, but are at greater risk for adverse events, research shows.
The study, conducted among patients from 11 geographically diverse regions in the USA, showed that those who underwent gastric bypass lost a significant 5.9 percentage points more weight at 1 year and a significant 6.7 percentage points more at 5 years than those who underwent sleeve gastrectomy.
Compared with gastric banding, the weight loss was 17.7 and 13.9 percentage points greater with gastric bypass at 1 and 5 years, respectively. The weight loss was also significantly greater with sleeve gastrectomy than with gastric banding.
David Arterburn (Kaiser Permanente Washington Health Research Institute, Seattle, USA) and co-investigators describe the weight loss differences as “clear and clinically important.”
They add: “These findings are compelling because recent smaller studies have suggested little or no difference in short-term weight loss” between gastric bypass and sleeve gastrectomy.
Average total weight loss at 1 year was 31.2% (mean 39.6 kg) among the 24,982 patients who underwent Roux-en-Y gastric bypass between 2005 and 2015, 25.2% (mean 32.0 kg) among the 18,961 who had sleeve gastrectomy, and 13.7% (mean 17.3 kg) among the 2567 who underwent adjustable gastric banding.
Weight loss continued for approximately 1.5 years in each group, after this time participants in each group slowly regained weight for the next 4 years. In spite of this, mean total weight loss at 5 years remained significantly higher with gastric bypass than with sleeve gastrectomy or gastric banding, at 25.5% versus 18.8% and 11.7%, respectively.
When the researchers analyzed the data among patient subgroups they found that the degree of weight loss tended to be lower in patients with diabetes, those with a BMI less than 50 kg/m2, African–Americans, and those aged 65 years or older, but they say that “the magnitudes of the differences in [total weight loss] were clinically small and generally less than 3%.”
Of note, major adverse events, defined as death, reoperation, percutaneous or endoscopic intervention, venous thromboembolism, or failure to be discharged from the hospital within 30 days, were a significant 1.57 and 1.66 times more likely to occur in patients undergoing gastric bypass than in those undergoing sleeve gastrectomy or gastric banding, respectively, with corresponding rates of 5.0%, 2.6%, and 2.9%.
However, Arterburn and co-authors caution that “future studies should examine longer-term differences in safety outcomes across procedures.”
Writing in the Annals of Internal Medicine, the team concludes: “Health care providers, patients, and policymakers can use these data to inform treatment and insurance coverage decisions.”
By Laura Cowen
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