Roughly 2x the weight loss in DS group vs GB at 10 years... but might not be worth the complication risk
jamanetwork.com
"Key Points
Question What are the outcomes 10 years after Roux-en-Y gastric bypass and duodenal switch surgery regarding weight control, metabolic health, quality of life, and complications in patients with a body mass index (BMI) of 50 to 60?
Findings In this randomized clinical trial of 60 participants, the reductions in body weight and BMI were greater after duodenal switch. Although metabolic markers improved more after duodenal switch, this procedure was also associated with more adverse effects, including nutritional complications.
Meaning Duodenal switch may not be superior to Roux-en-Y gastric bypass as treatment for patients with BMI of 50 to 60.
Conclusions
Although DS enables a greater BMI reduction over time and some cardiometabolic benefits, this comes at a cost regarding nutritional deficiencies and adverse effects. The balance between potential benefits and potential adverse effects is delicate, and a larger weight loss per se may not justify an increased risk. Despite the initial hypothesis in this randomized clinical trial that DS was a superior option to RYGB in patients with a BMI of greater than 50, we have ultimately concluded with the opposite, and DS with a short common channel (<200 cm) is currently no longer used in our institutions. For strictly selected patients with particularly high BMI and related comorbidity, the risk and benefit balance may justify the use of DS in experienced centers. The developing landscape of obesity treatment may suggest prioritizing bariatric techniques with the most optimal risk-benefit profile and adding modern weight loss medications when needed."
Ten-Year Outcomes Following RYGB vs Duodenal Switch for High BMI
This randomized clinical trial compares 10-year outcomes of Roux-en-Y-gastric bypass and duodenal switch surgery among patients with severe obesity.
jamanetwork.com
"Key Points
Question What are the outcomes 10 years after Roux-en-Y gastric bypass and duodenal switch surgery regarding weight control, metabolic health, quality of life, and complications in patients with a body mass index (BMI) of 50 to 60?
Findings In this randomized clinical trial of 60 participants, the reductions in body weight and BMI were greater after duodenal switch. Although metabolic markers improved more after duodenal switch, this procedure was also associated with more adverse effects, including nutritional complications.
Meaning Duodenal switch may not be superior to Roux-en-Y gastric bypass as treatment for patients with BMI of 50 to 60.
Conclusions
Although DS enables a greater BMI reduction over time and some cardiometabolic benefits, this comes at a cost regarding nutritional deficiencies and adverse effects. The balance between potential benefits and potential adverse effects is delicate, and a larger weight loss per se may not justify an increased risk. Despite the initial hypothesis in this randomized clinical trial that DS was a superior option to RYGB in patients with a BMI of greater than 50, we have ultimately concluded with the opposite, and DS with a short common channel (<200 cm) is currently no longer used in our institutions. For strictly selected patients with particularly high BMI and related comorbidity, the risk and benefit balance may justify the use of DS in experienced centers. The developing landscape of obesity treatment may suggest prioritizing bariatric techniques with the most optimal risk-benefit profile and adding modern weight loss medications when needed."
