Comparative Efficacy of Bariatric Surgery in the Treatment of Morbid Obesity and Diabetes Mellitus: a Systematic Review and Network Meta-Analysis

Korean Research Group for Endoscopic Management of Metabolic Disorder and Obesity

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Introduction: The comparative efficacy of various bariatric procedures has not been completely elucidated. We aimed to evaluate efficacy and safety of various bariatric procedures comprehensively. Methods: We searched for randomized controlled trials investigating the efficacy of bariatric surgery. Network meta-analyses were performed to determine the percentage of excess weight loss (%EWL) and remission of diabetes mellitus (DM). Results: Of 45 studies, 33 and 24 provided the data for %EWL and DM remission rates, respectively. Six months after surgery, biliopancreatic diversion with duodenal switch (BPD-DS), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy (SG) showed superior efficacy for %EWL compared to the standard-of-care (mean difference [MD], [95% confidence interval [CI]]: BPD-DS, 38.2% [7.3%, 69.1%]; RYGB, 32.1% [3.1%, 61.1%]; SG, 32.5% [5.5%, 59.5%]). However, adjustable gastric banding was not superior to standard-of-care (MD [95% CI] = − 0.2% [− 19.6%, 19.2%]). At 1 year, all bariatric procedures were superior to standard-of-care. At 3 years, RYGB and SG showed superior efficacy when compared to standard-of-care (MD [95% CI]: RYGB, 45.0% [21.8%, 68.2%]; SG, 39.2% [15.2%, 63.3%]). With respect to DM remission 3–5 years after surgery, BPD-DS, RYGB, and SG were superior to standard-of-care. Hernias, obstruction/stricture, bleeding, and ulcers were less common in patients who underwent SG than in those who underwent RYGB. Conclusions: RYGB and SG had excellent long-term outcomes for both the %EWL and DM remission rates. Additionally, SG had a relatively lower risk of adverse events than RYGB.

Original languageEnglish
Pages (from-to)2180-2190
Number of pages11
JournalObesity Surgery
Volume29
Issue number7
DOIs
Publication statusPublished - 2019 Jul 15

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Bariatric Surgery
Gastric Bypass
Morbid Obesity
Gastrectomy
Diabetes Mellitus
Standard of Care
Biliopancreatic Diversion
Bariatrics
Confidence Intervals
Therapeutics
Network Meta-Analysis
Hernia
Ulcer
Weight Loss
Stomach
Pathologic Constriction
Randomized Controlled Trials
Hemorrhage
Safety

Keywords

  • Bariatric surgery
  • Diabetes
  • Excessive weight loss
  • Metabolic surgery
  • Network meta-analysis

ASJC Scopus subject areas

  • Surgery
  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics

Cite this

Comparative Efficacy of Bariatric Surgery in the Treatment of Morbid Obesity and Diabetes Mellitus : a Systematic Review and Network Meta-Analysis. / Korean Research Group for Endoscopic Management of Metabolic Disorder and Obesity.

In: Obesity Surgery, Vol. 29, No. 7, 15.07.2019, p. 2180-2190.

Research output: Contribution to journalArticle

Korean Research Group for Endoscopic Management of Metabolic Disorder and Obesity. / Comparative Efficacy of Bariatric Surgery in the Treatment of Morbid Obesity and Diabetes Mellitus : a Systematic Review and Network Meta-Analysis. In: Obesity Surgery. 2019 ; Vol. 29, No. 7. pp. 2180-2190.
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abstract = "Introduction: The comparative efficacy of various bariatric procedures has not been completely elucidated. We aimed to evaluate efficacy and safety of various bariatric procedures comprehensively. Methods: We searched for randomized controlled trials investigating the efficacy of bariatric surgery. Network meta-analyses were performed to determine the percentage of excess weight loss ({\%}EWL) and remission of diabetes mellitus (DM). Results: Of 45 studies, 33 and 24 provided the data for {\%}EWL and DM remission rates, respectively. Six months after surgery, biliopancreatic diversion with duodenal switch (BPD-DS), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy (SG) showed superior efficacy for {\%}EWL compared to the standard-of-care (mean difference [MD], [95{\%} confidence interval [CI]]: BPD-DS, 38.2{\%} [7.3{\%}, 69.1{\%}]; RYGB, 32.1{\%} [3.1{\%}, 61.1{\%}]; SG, 32.5{\%} [5.5{\%}, 59.5{\%}]). However, adjustable gastric banding was not superior to standard-of-care (MD [95{\%} CI] = − 0.2{\%} [− 19.6{\%}, 19.2{\%}]). At 1 year, all bariatric procedures were superior to standard-of-care. At 3 years, RYGB and SG showed superior efficacy when compared to standard-of-care (MD [95{\%} CI]: RYGB, 45.0{\%} [21.8{\%}, 68.2{\%}]; SG, 39.2{\%} [15.2{\%}, 63.3{\%}]). With respect to DM remission 3–5 years after surgery, BPD-DS, RYGB, and SG were superior to standard-of-care. Hernias, obstruction/stricture, bleeding, and ulcers were less common in patients who underwent SG than in those who underwent RYGB. Conclusions: RYGB and SG had excellent long-term outcomes for both the {\%}EWL and DM remission rates. Additionally, SG had a relatively lower risk of adverse events than RYGB.",
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AU - Korean Research Group for Endoscopic Management of Metabolic Disorder and Obesity

AU - Park, Chan Hyuk

AU - Nam, Seung Joo

AU - Choi, Hyuk Soon

AU - Kim, Kyoung Oh

AU - Kim, Do Hoon

AU - Kim, Jung Wook

AU - Sohn, Won

AU - Yoon, Jai Hoon

AU - Jung, Sung Hoon

AU - Hyun, Yil Sik

AU - Lee, Hang Lak

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N2 - Introduction: The comparative efficacy of various bariatric procedures has not been completely elucidated. We aimed to evaluate efficacy and safety of various bariatric procedures comprehensively. Methods: We searched for randomized controlled trials investigating the efficacy of bariatric surgery. Network meta-analyses were performed to determine the percentage of excess weight loss (%EWL) and remission of diabetes mellitus (DM). Results: Of 45 studies, 33 and 24 provided the data for %EWL and DM remission rates, respectively. Six months after surgery, biliopancreatic diversion with duodenal switch (BPD-DS), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy (SG) showed superior efficacy for %EWL compared to the standard-of-care (mean difference [MD], [95% confidence interval [CI]]: BPD-DS, 38.2% [7.3%, 69.1%]; RYGB, 32.1% [3.1%, 61.1%]; SG, 32.5% [5.5%, 59.5%]). However, adjustable gastric banding was not superior to standard-of-care (MD [95% CI] = − 0.2% [− 19.6%, 19.2%]). At 1 year, all bariatric procedures were superior to standard-of-care. At 3 years, RYGB and SG showed superior efficacy when compared to standard-of-care (MD [95% CI]: RYGB, 45.0% [21.8%, 68.2%]; SG, 39.2% [15.2%, 63.3%]). With respect to DM remission 3–5 years after surgery, BPD-DS, RYGB, and SG were superior to standard-of-care. Hernias, obstruction/stricture, bleeding, and ulcers were less common in patients who underwent SG than in those who underwent RYGB. Conclusions: RYGB and SG had excellent long-term outcomes for both the %EWL and DM remission rates. Additionally, SG had a relatively lower risk of adverse events than RYGB.

AB - Introduction: The comparative efficacy of various bariatric procedures has not been completely elucidated. We aimed to evaluate efficacy and safety of various bariatric procedures comprehensively. Methods: We searched for randomized controlled trials investigating the efficacy of bariatric surgery. Network meta-analyses were performed to determine the percentage of excess weight loss (%EWL) and remission of diabetes mellitus (DM). Results: Of 45 studies, 33 and 24 provided the data for %EWL and DM remission rates, respectively. Six months after surgery, biliopancreatic diversion with duodenal switch (BPD-DS), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy (SG) showed superior efficacy for %EWL compared to the standard-of-care (mean difference [MD], [95% confidence interval [CI]]: BPD-DS, 38.2% [7.3%, 69.1%]; RYGB, 32.1% [3.1%, 61.1%]; SG, 32.5% [5.5%, 59.5%]). However, adjustable gastric banding was not superior to standard-of-care (MD [95% CI] = − 0.2% [− 19.6%, 19.2%]). At 1 year, all bariatric procedures were superior to standard-of-care. At 3 years, RYGB and SG showed superior efficacy when compared to standard-of-care (MD [95% CI]: RYGB, 45.0% [21.8%, 68.2%]; SG, 39.2% [15.2%, 63.3%]). With respect to DM remission 3–5 years after surgery, BPD-DS, RYGB, and SG were superior to standard-of-care. Hernias, obstruction/stricture, bleeding, and ulcers were less common in patients who underwent SG than in those who underwent RYGB. Conclusions: RYGB and SG had excellent long-term outcomes for both the %EWL and DM remission rates. Additionally, SG had a relatively lower risk of adverse events than RYGB.

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KW - Diabetes

KW - Excessive weight loss

KW - Metabolic surgery

KW - Network meta-analysis

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