Top bariatric surgery news in 2022: Exploring trends in gastric bypass, sleeve gastrectomy

Endoscopic bariatric surgery within the past few years has become a hot topic in the field of gastroenterology as a way to improve outcomes in patients who are obese or have nonalcoholic fatty liver disease.

In 2022, research on bariatric surgery included adding weight management to NAFLD care to boost bariatric surgery referrals, improvements in patient outcomes after endoscopic sleeve gastrectomy and Roux-en-Y gastric bypass, FDA and industry news regarding sleeve gastrectomy and a precision medicine platform for obesity treatment and more.

Healio provides a handpicked selection of our top news coverage from 2022 on bariatric surgery.

Adding weight management to NAFLD care boosts bariatric surgery referrals 25-fold

Adding weight management care into a multidisciplinary nonalcoholic fatty liver disease program improved referrals for bariatric surgery at a rate of 25 times higher than the national average, according to Yale study results.

“Losing at least 10% of your body weight is the treatment for fatty liver disease, and there are many ways to lose weight on the market, including new medications and bariatric surgery,” Ysabel Ilagan-Ying, MD, a hospital resident at Yale University School of Medicine and West Haven Veterans Medical Center, said during The Liver Meeting media briefing. “However, only an estimated 1% of eligible patients are appropriately referred to bariatric surgery.” Read more.

VIDEO: What’s in a name? The young surgeon behind the Roux-en-Y anastomosis

In this Endo-Sketch, a Healio video series on clinical conditions named after famous colleagues, Klaus Mergener, MD, of the University of Washington School of Medicine, discusses the origin of Roux-en-Y anastomosis.

According to Mergener, this end-to-side surgical technique between the distal jejunum and stomach, was first performed by César Roux. Roux was born in Switzerland in 1857 and was appointed chief of surgery at the Canton Hospital in Lausanne when he was just 30 years old. He later became professor of clinical surgery and gynecology when the University of Lausanne was founded in 1890. Watch here.

Endoscopic sleeve gastroplasty induces, maintains weight loss in mild, moderate obesity

Endoscopic sleeve gastroplasty safely induced and maintained weight loss and improved metabolic comorbidities in patients with class 1 and class 2 obesity, according to research published in The Lancet.

“Endoscopic sleeve gastroplasty (ESG) is a procedure that is performed through the mouth with an endoscope to reduce the size of the stomach for weight loss and metabolic improvement in diseases such as diabetes,” Barham K. Abu Dayyeh, MD, MPH, director of advanced endoscopy and professor of gastroenterology and hepatology at the Mayo Clinic in Rochester, Minnesota, told Healio. “This procedure does not require surgery and preserves the stomach; unlike surgery, the stomach is not cut and removed. Thus, the procedure is an appealing, minimally invasive option for many patients suffering from the disease of obesity. Read more.

FDA grants de novo clearance for endoscopic sleeve gastroplasty, bariatric revision devices

The FDA has granted de novo authorization for Apollo Endosurgery to market its Apollo ESG and Apollo REVISE endoscopic systems for the treatment of patients with obesity, according to a company press release.

These are the first devices authorized by the FDA for endoscopic sleeve gastroplasty and endoscopic bariatric revision procedures. Read more.

Weight loss via endoscopic bariatric therapies improves ‘all major NAFLD outcomes’

Weight loss induced by FDA-approved endoscopic bariatric and metabolic therapies improved several features of nonalcoholic fatty liver disease, with significant improvement in liver fibrosis, according to research.

“Our study demonstrates that [endoscopic bariatric and metabolic therapies (EBMTs)] are associated with significant improvement in all major NAFLD surrogates, including liver fibrosis,” Pichamol Jirapinyo, MD, MPH, of Brigham and Women’s Hospital in Boston, and colleagues, wrote in Clinical Gastroenterology and Hepatology. “In addition, all surrogate markers of insulin resistance including [homeostasis model assessment of insulin resistance (HOMA-IR)], fasting glucose and fasting insulin significantly improve, suggesting possible mechanisms of how EBMTs affect NAFLD improvement.” Read more.

Phenomix Sciences uses precision medicine platform to predict obesity treatment outcomes

Phenomix Sciences has launched their Phenomix Sciences Obesity Platform, a set of data and tools that personalize obesity treatments.

“The Platform was developed with a goal to combat obesity with data-driven medicine,” Mark Bagnall, CEO of Phenomix, told Healio. “Obesity isn’t one disease, but many, and at least four can be determined by phenotyping. In fact, the four phenotype categories account for 90% of obese patients. Phenomix is the first to bring a solution to market based on the science of phenotyping.” Read more.

Pain, disability improvements endure 7 years after bariatric surgery

Two-thirds of patients who underwent Roux-en-Y gastric bypass and sleeve gastrectomy experienced clinically important improvements in pain and physical function 7 years after surgery, according to research published in JAMA Network Open.

“Previous studies had provided evidence that bariatric surgical procedures are associated with improvements in pain, physical function and work productivity. However, most prior studies only followed participants 1 to 2 years, at which point participants were at the peak of their weight loss,” Wendy C. King, PhD, associate professor of epidemiology at the University of Pittsburgh, told Healio. “Among a large cohort of U.S. adults, we wanted to evaluate how much initial improvements in pain, physical function and work productivity declined during long-term follow-up, when some degree of weight regain is not uncommon.” Read more.

Higher risk for hospitalization, mortality in Black, Hispanic patients after Roux-en-Y

While both Roux-en-Y gastric bypass and sleeve gastrectomy resulted in weight loss and lower HbA1c across all racial and ethnic groups, Black and Hispanic patients who underwent gastric bypass experienced more postsurgical complications.

“Both observational studies and clinical trials over the last 10 years have shown that there is no other intervention that is as effective as metabolic and bariatric surgery for durable weight loss and comorbidity remission (eg, type 2 diabetes),” Karen J. Coleman, PhD, of the department of research and evaluation at Kaiser Permanente Southern California, and colleagues wrote in JAMA Surgery. “There is limited evidence, however, that racial and ethnic groups of patients may not benefit in the same way from metabolic and bariatric surgery.” Read more.

Sleeve gastrectomy selection soared nearly 2000% following Medicare coverage change

The 2012 Medicare change to cover sleeve gastrectomy, in addition to Roux-en-Y gastric bypass, for bariatric surgery boosted its selection exponentially, with significant regional and temporal variation between states.

In data published in JAMA Network Open, researchers also noted that the selection of sleeve gastrectomy over gastric bypass depended on how widely used that procedure was used in that state during the prior year. Read more.

Sleeve gastrectomy beneficial, but with greater risk for self-harm, substance use disorder

Sleeve gastrectomy for class 1 obesity led to more weight loss and diabetes prevention compared with intensive lifestyle modification but was linked to higher risks for substance use disorder and self-harm, according to new data.

“By being perceived as a technically less challenging operation than the gastric bypass procedure, with a shorter operation time and a general view that short-term complications may be lower, sleeve gastrectomy is often considered for patients with class 1 obesity despite the lack of strong scientific support,” Erik Stenberg, MD, PhD, from the department of surgery from Örebro University Hospital in Sweden, and colleagues wrote in JAMA Network Open. Read more.