Bariatric Times

ICCDS-1 2016

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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B12 Bariatric Times • November 2016 • Supplement B FIRST INTERNATIONAL CONSENSUS CONFERENCE ON DUODENAL SWITCH T he concept of duodenal switch (DS) was imagined in 1987 by DeMeester et al 1 for the treatment of bile reflux. The technique was then adapted to bariatric surgery in 1989 by Hess et Marceau 2,3 and did not evolve much, up until very recently, with the description of single anastomosis DS by Pernaute et al. 4 In short, the DS involves 1) the creation of a large sleeve gastrectomy, 2) a 250- cm total alimentary limb connected to the duodenum, and 3) the creation of a 100-cm common channel. Long-term outcomes are particularly important in the bariatric field due to the chronic nature of obesity and the high risk of recurrence of comorbidities if the patient regains weight. However, only a few centers have reported their outcomes with DS beyond five years 5–9 in a significant number of patients (>100 patients). These studies are summarized in Table 1. Overall, long-term outcomes after DS are excellent, with a mean excess weight loss (EWL) between 65 and 76 percent, and a cure rate of metabolic syndrome in the vast majority of patients. More specifically, type 2 diabetes mellitus (T2DM) usually goes into remission in more than 90 percent of patients for T2DM on oral medications, and between 67 and 80 percent when the patient is on insulin. Hypertension is usually cured in 60 percent and dyslipidemia in 80 to 96 percent. 5–9 These results seem stable over time. Indeed, Buchwald et al 9 looked at data from 4,035 DS patients from 32 studies, with a shorter follow-up of two years. In that meta-analysis, the mean EWL was 70 percent, improvement or remission of T2D was 98 percent of patients, resolution of hypertension occurred in 81 percent, resolution of sleep apnea in 95 percent, and improvement of hyperlipidemia in 99 percent. In addition, the long-term risk of nutritional deficiencies, and particularly acute protein malnutrition, warrants a systematic follow up after DS. In our 10-year experience with DS, 7 protein malnutrition occurred in 10 percent of the population, with five percent requiring readmission and one percent surgical revision for malnutrition or side effects. Side effects include increased number of bowel movements (mean of 3.2), frequent bloating (48%), and annoyance caused by odor of stools and gas (70%). Overall long-term satisfaction remains high at 95 percent, with a satisfaction in regards to the weight loss itself at 77 percent. In conclusion, DS offers sustained weight loss and marked effect on comorbidities, while preserving normal physiological emptying of the stomach. Long- term patients' satisfaction with the overall result is high (95%), even if gastro-intestinal side-effects are present in the majority of patients. Long-term follow-up and adherence to dietary recommendations (including lifelong vitamin supplements) is necessary following DS. The excellent long- term medical benefits and improvement in quality of life come at the expense of some gastrointestinal side effects and vitamin supplementation. • Long-term percentage of excess weight loss after duodenal switch ranges between 65 and 75 percent • Type 2 diabetes goes into remission in more than 90 percent of patients on oral medications • Protein malnutrition occurs in 10 percent of patients and surgical revision is required in one percent. • Overall, patients' satisfaction with duodenal switch is high, with 95 percent of patients grading their satisfaction level at 4 or 5 out of 5. KEY POINTS Long-Term Results of Duodenal Switch Laurent Biertho, MD Bariatric Times. 2016;13(11 Suppl B):B12–B13. AUTHOR AFFILIATIONS: Laurent Biertho, MD, is from the Department of Surgery, Quebec Heart and Lung Institute, Laval University, Quebec, Quebec City, Canada. ADDRESS FOR CORRESPONDENCE: Dr. Laurent Biertho, Quebec Heart and Lung Institute, 2725 Ch Sainte Foy, G1X 4V5, Quebec, QC, CA; Email: Laurent.biertho@criucpq.ulaval.ca FUNDING AND DISCLOSURES: No funding was provided. Dr. Biertho reports no conflicts of interest relevant to the content of this article.

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