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Greater benefits and risks found with duodenal switch vs. gastric bypass
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Compared with Roux-en-Y gastric bypass, biliopancreatic diversion with duodenal switch resulted in greater weight loss and improvements in blood lipids and glucose 5 years after surgery, according to recent study findings published in JAMA Surgery.
However, according to the researchers, patients who underwent duodenal switch experienced more long-term surgical and nutritional complications as well as more adverse gastrointestinal effects compared with those who underwent gastric bypass.
Torsten Olbers, MD, PhD, of the department of gastrosurgical research and education, Sahlgrenska Academy at the University of Gothenburg in Sweden, and colleagues evaluated 60 adults aged 20 to 50 years with a BMI of 50 kg/m2 to 60 kg/m2 who underwent Roux-en-Y gastric bypass (n = 31) or biliopancreatic diversion with duodenal switch (n = 29) and compared the 5-year outcomes of each.
After 5 years, BMI and weight reductions were greater among the duodenal switch group compared with the gastric bypass group (P < .001 for both). Similarly, total body weight loss was greater after 5 years for the duodenal switch group compared with the gastric bypass group (P < .001).
Duodenal switch, but not gastric bypass, resulted in statistically significant decreases from baseline in total cholesterol, LDL cholesterol, diastolic blood pressure and mean fasting plasma glucose.
Six patients who underwent duodenal switch and five in the gastric bypass group had type 2 diabetes before surgery; none used glucose-lowering medication 5 years after surgery, and remission was met by all patients who underwent duodenal switch.
Compared with gastric bypass, duodenal switch yielded greater reductions in serum concentrations of vitamin A, 25-hydroxyvitamin D and ionized calcium, and a significant increase in parathyroid hormone.
Gastrointestinal adverse effects were more common in the duodenal switch group. More surgical procedures related to the initial procedure and hospital admissions were found among patients who underwent duodenal switch.
“In our study, duodenal switch resulted in greater weight loss and greater improvement in blood lipids and glucose compared with gastric bypass across 5 years in patients with baseline BMI of 50 to 60 [kg/m2],” the researchers wrote. “Improvement in [health-related quality of life] were comparable. However, duodenal switch was associated with more long-term surgical and nutritional complications and more gastrointestinal adverse effects compared with gastric bypass.”
In an accompanying editorial, Justin B. Dimick, MD, MPH, and Oliver A. Varban, MD, both of the department of surgery at the University of Michigan, wrote that the high complication rates of duodenal switch reported in the study make that surgery difficult to recommend as a “first-line weight loss procedure.”
“At the very least, patients seeking this procedure should receive ample warning regarding the very high risks of adverse nutritional outcomes and the high reoperation rate,” they wrote. “Patients with poor compliance and poor follow-up should not be offered this procedure because they could be at risk of fatal complications if postoperative problems are not addressed in a timely fashion.”
Disclosure: Olbers reports financial ties with Johnson and Johnson. Dimick co-founded ArborMetrix. Please see the full study for a list of all other authors’ relevant financial disclosures.
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