Five year data on SADI-S

[southernlady]

Laparoscopic single-anastomosis duodenal-jejunal bypass with sleeve gastrectomy (SADJB-SG): Surgical risk and long-term results

Single-anastomosis duodeno-jejunal bypass with sleeve gastrectomy (SADJB-SG) was developed as a simplified technique of DJB-SG, but long-term data are…

www.sciencedirect.com

Elizabeth Gilchrist on the FB side of this forum posted this link and included some breakdown:

”There are 5 year data about one of the DS variants in Taiwan. They called it Single-anastomosis duodeno-jejunal bypass with sleeve gastrectomy (SADJB-SG). The two most important issues for me were durability of weight loss and resolution of diabetes. This isnt a head-to-head comparison with DS, but it comments on durability of weight loss and diabetes. At postoperative 1, 2, and 5 years, the mean excess weight loss was 83.9%, 76.1%, 58.6%. So if you were 100 pounds overweight, you would be down 84 pounds in year one and down 59 at year 5...or 25 pounds regain. if you were 200 pounds overweight, the regain would be 50 pounds. About half of the patients with T2D achieved complete remission (hemoglobin A1C <60%) at 1 year but that dropped to 36.5% at Year 5. Over time, 15 patients needed reoperation for weight regain, return of diabetes and reflux etc. At 5 years, about one fourth (14/57) of the remaining required proton pump inhibitor for reflux symptoms. That is the most concerning thing because reflux over a very long time is linked to esophageal cancer. If you translated these to my life, durability for me with the one anastomoses procedure vs my DS would mean I would weigh 195 lbs instead of 145 and I would only have a one third chance of still not having diabetes. At 15 years, I don’t have diabetes after DS and my regain is about 18 pounds over 15 years. Maybe vitamin abnormalities and anemia will be better with the one anastomoses procedures. Time will tell. ”

 

[hilary1617]

Good information. Thanks for letting us know. I think most of us expected to learn of significant regain with SADI/SIPS/LOOP-DS, but even understanding technically that it was a risk, having not seen many actual complaints about it, I'm stunned at the prevalance of reflux. That's really concerning.

 

[DianaCox]

These are really crappy results as compared to a traditional DS.

 

[southernlady]

These are really crappy results as compared to a traditional DS.

True. However compared to the RNY?

 

[JackieOnLine]

True. However compared to the RNY?

a low bar?

 

[DianaCox]

Methods

A total of 148 SADJB-SG was performed from 2011 to 2016 with mean age of 42.0 ± 10.9-years old (14–71), female 64.9%, and mean body mass index 34.2 ± 5.9 kg/m2. All patients were evaluated and managed under a strict multidisciplinary team approach. A retrospective analysis of a prospective bariatric database and telephone interview of patients who defaulted clinic follow-up at 5-year was conducted.
Results
The mean operating time, intraoperative blood loss, and hospital stay of SADJB-SG were 189.6 ± 32.1 minutes, 43.5 ± 17.9 mL, and 5.0 ± 5.1 days, respectively. The 30-days postoperative major complication occurred in 7(4.7%) patients, all in patients with type 2 diabetes (T2D). At postoperative 1, 2, and 5 years, the mean percentage of total weight loss and excess weight loss of SADJB-SG patients were 25.5%, 22.8%, 22.5%, and 83.9%, 76.1%, 58.6%, respectively. Among 118 patients with T2D, 62 (52.5%) achieved complete remission (hemoglobin A1C <60%) at 1 year and 36.5% at 5 years after surgery. A total of 15 patients needed reoperation [>10%] at follow-up, due to reflux disease (n = 11), weight regain, and recurrent of T2D (n = 2), ileus (n = 1), and peritonitis (n = 1). Among them, 8 were converted to RYGB and the others remained in same anatomy. At 5 years, the overall revision rate was 12.9% (8/62) and 24.5% (14/57) of the remaining required proton pump inhibitor for reflux symptoms.

These numbers are so much worse than a proper DS! And the average starting BMI was below 35!! You can’t even get insurance coverage at that BMI, even with diabetes!

If I recall correctly, with a proper DS at 10 years, the approximate % EWL is 75%; the T2D cure/remission rate is 87% or more; and the revision rate was well below 1%. I didn’t look these numbers up, but they are pretty close.

 

[RainCity]

Are the 5 year results better, worse, or the same as RNY?

 

[DianaCox]

Worse than RNY.

Bariatric metabolic surgery: Advances continue

This article reviews metabolic procedures and highlights their safety profiles since the establishment of large data registries and accreditation programs.

bulletin.facs.org

Table 3. Randomized trials comparing SG and RYGB



RYGB
RYGB is the bariatric procedure with the longest active history. Although it has taken various forms over the years and continues to be performed around the world both as a Roux-en-Y as well as in a loop configuration, most of the literature reports the results of the RYGB. According to the most recent estimates, RYGB comprised 19 percent of the bariatric metabolic procedures performed in 2016 (see Table 1). The relatively rapid decline in the number of RYGB operations performed in recent years (37 percent in 2011) is directly related to the increasing number of SGs performed.

RYGB has proven to have sustained, long-term weight loss and metabolic effects. In the last five years, 38 RYGB series with more than five years of follow-up have been published. According to a review performed by the ASMBS Clinical Issues Committee in preparation for a statement on the durability of bariatric procedures, the long-term weight loss after RYGB ranged from 50 percent to 72 percent excess weight loss; 19 percent to 35 percent total weight loss was reported over the long term. Outcomes of studies demonstrating the durability of RYGB beyond five years with more than 100 patients at follow-up are shown in Table 4.21-39

Table 4. Long-term outcomes of gastric bypass with follow-up >5 years (n>100)



As previously stated, several metabolic mechanisms affect the efficacy of RYGB. Many of the individual components of the gastric bypass procedure have served as targets of therapy for novel endoscopic devices or medications. At least five different components contribute to the metabolic effects of this operation, including gastric volume reduction (exclusion of ghrelin-producing cells); caloric restriction; partial vagotomy; exclusion of nutrient flow through the distal stomach, duodenum, and proximal jejunum; and the rapid nutrient transit into the distal bowel. The relative contribution of each of these mechanisms in the overall metabolic effect is unknown; yet, ample animal and human data suggest that rapid transit of nutrients into the distal bowel, and duodenal exclusion, may drive most of the weight loss-independent metabolic effects of RYGB.40 Other potential mechanisms, such as increased bile acid circulation and changes in the gut microbiome, are being studied.41

The effects of gastric bypass on remission or improvement of type 2 diabetes have been repeatedly demonstrated over the last 30 years. Overall remission rates are 80 percent, but individual phenotypes demonstrate variable responses to the operation. Patients with long-standing diabetes or who require insulin at the time of surgery (both indicators of poor beta-cell reserve) are less likely to achieve remission but still may enjoy better diabetes control and fewer medications.18,23,42,43Diabetes recurs in some patients long after gastric bypass. Most long-term studies demonstrate 50 percent to 60 percent remission rates beyond five years—possibly as a result of some weight regain or a progression of this chronic disease that was put into remission for several years.44,45 Whatever the length of a period of remission, it may extend the onset for that length of time of chronic type 2 diabetes ocular or vascular complications. The STAMPEDE trial confirmed that gastric bypass patients had improved insulin sensitivity compared with SG patients and medical patients, which correlated with a significant decrease in truncal fat after bypass that was not found after SG.46 Long-term remission rates of other metabolic diseases, such as hypertension and hyperlipidemia, are reported to be in the range of 40 percent to 60 percent. Long-term survival for patients who underwent gastric bypass improves by 30 percent to 40 percent compared with similar patients who did not undergo surgery. This effect is primarily the result of decreased cardiovascular and cancer risk.47-49 At present, 11 randomized trials demonstrate the superiority of bariatric surgery over medical treatment for diabetes.50 In addition, three randomized clinical trials compare safety, weight loss, gastroesophageal reflux, and quality of life after SG and RYGB (see Table 2).18,19,51

 

[southernlady]

Okay, so the ONLY advantage it has over the RNY is it preserves the pyloric valve.

 

[DianaCox]

And therefore, the SADI results should have been BETTER than the DS results, if the surgeries were comparable.

 

[galaxygrrl]

Is anyone suprised with this? I'm not, but boy do I feel sorry for the people who got the SADI's