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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Page 20 of 32

B20 Bariatric Times • November 2016 • Supplement B FIRST INTERNATIONAL CONSENSUS CONFERENCE ON DUODENAL SWITCH verified by Still et al. 5 For those with long standing diabetes that have r equired insulin for many years, the remission rate is less than 25 percent. 5 In the single randomized controlled trial that included BPD, which was published in the New E ngland Journal of Medicine, there was clear superiority for BPD as compared to RYGB. 6 Both arms were significantly superior to medical therapy. 6 In another randomized trial by Schauer et al, 7 both VSG and RYGB were superior to medical therapy at one and at three years. Additionally, there was not statistical difference between VSG and RYGB; however, the authors felt that at three years they were beginning to see an advantage for RYGB that would become more apparent with either time or increased subject number. 7 RYGB is not a definitive cure for type 2 diabetes. Although superior to medical therapy, a relapse rate of 30 percent has been reported in several major studies. 8 Additionally, the Swedish Obese Subjects study revealed that there was a 20-percent new onset rate of type 2 diabetes following RYGB. 9 Bariatric surgery has become an accepted modality for diabetes because manipulation of the gastro intestinal tract alters endocrine function and numerous factors that become distorted by the disease process. There is increased insulin produced and beta cell sensitivity improves. 10 Hepatic glucose production is suppressed and hepatic insulin sensitivity normalizes. There is an increased release of incretins (GLP, GIP), which stimulate insulin production, delay gastric emptying and potentially alter satiety. 11 A major challenge is procedure selection. Some metabolic surgeons believe that LAGB is an adequate procedure and others (the majority based on our observations), believe that RYGB is the standard. However, F i g u r e 1 . I l l ust rat i on of t he St omach, I nt est i ne, and Pyl ori c Spari ng Surger y (SI PS) procedure Table 1. Results from Roslin et al series of 168 cases of SIPS (Stomach, Intestine and Pyloric Sparing Surgery: A Modified Duodenal Switch): Weight Loss MONTHS 1–3 (N=168) 4–6 (N=123) 7–12 (N=146) 13–18 (N=96) 19–26 (N=22) Total body weight loss (lbs) 36.8 79.3 110.4 120.9 138 Total body weight loss (%) 11.7 24.7 34.5 39 44.8 Excess weight loss (%) 21.9 45.5 65.5 74.5 82.5 BMI reduction (kg/m 2 ) 5.8 12.5 17.5 18.7 22.6 Excess BMI loss (%) 25.1 52 75.7 86.6 95.9 Table 2. Results from Roslin et al series of 168 cases of SIPS (Stomach, Intestine and Pyloric Sparing Surgery: A Modified Duodenal Switch): Adverse Events ADVERSE EVENT Post op diarrhea 5 Wound infections 3 Intra-abdominal hematoma 4 MVT 2 Stricture 1 Leak 1 Chylous Ascites 1 Death 1

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