A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional
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April 2015 • Supplement A • Bariatric Times A21 5 th INTERNATIONAL CONSENSUS SUMMIT FOR SLEEVE GASTRECTOMY Currently, there are two randomized trials comparing LSG w ith other bariatric procedures or medical treatment. In the first one, Schauer et al evaluated the effect of RYGB and LSG on the treatment of T2DM. 11 In their study titled, " Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently (STAMPEDE)," the primary endpoint was percent of patients achieving a hemoglobin A1c (HbA1c) below 6.0 percent, with or without diabetes medications. The study included patients with BMIs ranging from 27 to 43kg/m 2 and one group was also randomized only to medical treatment (control group). A total of 50 patients were included in each group. Overall, 40 percent of the patients in the RYGB and 37 percent in the LSG group achieved the primary end point. The difference was not statistically significant. The rate of serious complication requiring hospital readmission was higher after RYGB: 22 percent versus eight percent in LSG. In another randomized trial, Keidar et al found similar remission rates for T2DM after SG as compared to RYGB in patients with BMI above 35kg/m 2 . 12 The study had a smaller sample size than the STAMPEDE trial, with 41 patients randomized to LSG or RYGB. HbA1c, body composition, and glucose tolerance were evaluated at baseline, and at three and 12 months postoperatively. Of the 41 patients, 37 completed the follow up (19 RYGB, 18 SG). Both groups had similar baseline anthropometric and biochemical measures, and showed comparable weight loss and fat/fat-free mass ratio changes at 12 months. A similar normalization of HbA1c levels was observed as early as three months post-surgery (6.37±0.71% vs 6.23±0.69% for RYGB vs SG respectively, p < 0.001 in both groups for baseline vs. follow-up). The data on postoperative complications were n ot presented. Although, LSG is the "new kid on the block" when compared with other established bariatric surgery procedures worldwide, there is a g rowing body of research and clinical data suggesting that LSG has a substantial effect on T2DM, producing remission or improvement in most cases. REFERENCES 1. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta- analysis. JAMA. 2004;292(14):1724–1737. 2. Herman WH. The economic costs of diabetes: is it time for a new treatment paradigm? Diabetes Care. 2013;36(4):775–776. 3. Introduction: The American Diabetes Association's (ADA) evidence-based practice guidelines, standards, and related recommendations and documents for diabetes care. Diabetes Care. 2012;35 Suppl 1:S1–2. 4. Batchelder AJ, Williams R, Sutton C, Khanna A. The evolution of minimally invasive bariatric surgery. J Surg Res. 2013;183(2):559–566. 5. Angrisani L. Presidential Address. 19th World Congress of International Federation for the Surgery of Obesity & Metabolic Disorders (IFSO 2014), Montreal, QC, Canada, August 29, 2014. 6. Madsbad S, Holst JJ. GLP-1 as a mediator in the remission of type 2 diabetes after gastric bypass and sleeve gastrectomy surgery. Diabetes. 2014;63(10):3172–3174. 7. Evans S, Pamuklar Z, Rosko J, et al. Gastric bypass surgery restores meal stimulation of the anorexigenic gut hormones glucagon-like peptide-1 and peptide YY independently of caloric restriction. Surg Endosc. 2012;26(4):1086–1094. 8. Vidal J, Jimenez A. Diabetes remission following metabolic surgery: is GLP-1 the culprit? Curr Atheroscler Rep. 2013;15(10):357. 9. Lemanu DP, Srinivasa S, Singh PP, Hill AG, MacCormick AD. Laparoscopic sleeve gastrectomy: its place in bariatric surgery for the severely obese patient. N Z Med J. 2012;125(1359):41–49. 10. Li JF, Lai DD, Lin ZH. Comparison of the long-term results of Roux- en-Y gastric bypass and sleeve gastrectomy for morbid obesity: a systematic review and meta- analysis of randomized and nonrandomized trials. Surg Laparosc Endosc Percutan Tech. 2014;24(1):1–11. 11. Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366(17):1567–1576. 12. Keidar A, Hershkop KJ, Marko L, et al. Roux-en-Y gastric bypass vs sleeve gastrectomy for obese patients with type 2 diabetes: a randomised trial. Diabetologia. 2013;56(9):1914–1918.