Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2023 Oct;33(10):2981-2990.
doi: 10.1007/s11695-023-06767-0. Epub 2023 Aug 16.

Long-term Follow-up 15 Years After Duodenal Switch or Gastric Bypass for Super Obesity: a Randomized Controlled Trial

Filip Möller  1 , Jakob Hedberg  2 , Martin Skogar  2 , Magnus Sundbom  2
Affiliations
Randomized Controlled Trial

Long-term Follow-up 15 Years After Duodenal Switch or Gastric Bypass for Super Obesity: a Randomized Controlled Trial

Filip Möller et al. Obes Surg. 2023 Oct.

Abstract

Background: In super obesity, Roux-en-Y gastric bypass (RYGB) may be insufficient why some surgeons advocate biliopancreatic diversion with duodenal switch (BPD/DS), a more malabsorptive procedure. There is a paucity of evidence regarding results beyond 10 years, especially after BPD/DS. The aim of this randomized controlled trial was to compare the long-term outcome of BPD/DS, and RYGB in patients with super obesity, i.e., body mass index (BMI) > 50 kg/m2.

Methods: This is a 13- to 17-year follow-up study of a single-center, single-blinded randomized trial in which 47 patients (BMI > 48 and eligible for bariatric surgery) were randomized 1:1 to BPD/DS and RYGB (25 men, 24 BPD/DS, 39.1 ± 9.9 years, BMI 54.5 ± 6.1 kg/m2). The primary outcome was weight loss. The study was financed by Swedish governmental funding of clinical research (ALF).

Trial registration number: ISRCTN10940791.

Results: Thirty-four (18 BPD/DS) of the living 42 patients (81.0%) participated. BPD/DS resulted in higher BMI loss (20.4 ± 7.9 vs. 12.4 ± 8.6, p = .008) and higher percent of total body weight loss (37.5% ± 12.2 vs. 22.8% ± 14.8, p = .004). BPD/DS was associated with lower fasting glucose, glycated hemoglobin (HbA1c), and low-density lipoprotein (LDL) as well as lower hemoglobin. Adverse events were more common after BPD/DS (2.7 vs. 0.9 per patient, p = .004). The global assessment tool BAROS (Bariatric Analysis and Reporting Outcome System) demonstrated superior scores for BPD/DS (p = .047).

Conclusion: When compared to RYGB, BPD/DS results in superior weight loss and metabolic control as well as superior BAROS score, however, at the cost of more adverse events.

Keywords: BAROS; Bariatric surgery; Biliopancreatic diversion with duodenal switch; Diabetes mellitus; Long-term results; Obesity; Roux-en-Y gastric bypass; Weight loss.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Participant flow through the study
Fig. 2
Fig. 2
Weight loss, demonstrated as BMI at the actual time points. BMI, body mass index; BPD/DS, biliopancreatic diversion with duodenal switch; RYGB, Roux-en-Y gastric bypass; Preop, preoperative; 1y,  1 year postoperative; 3y, 3 years postoperative; 13–17y, 13–17 years postoperative
Fig. 3
Fig. 3
Biochemical profiles. BPD/DS, biliopancreatic diversion with duodenal switch; RYGB, Roux-en-Y gastric bypass; Preop, preoperative; 1y, 1 year postoperative; 3y, 3 years postoperative; 13–17y, 13–17 years postoperative; LDL, low density lipoprotein; HbA1c, glycated hemoglobin
Fig. 4
Fig. 4
Classification of the overall result based on the total BAROS score. BAROS, Bariatric Analysis and Reporting Outcome System; BPD/DS, biliopancreatic diversion with duodenal switch; RYGB, Roux-en-Y gastric bypass
See this image and copyright information in PMC

References

    1. Overweight & Obesity Statistics. National Institute of Diabetes and Digestive and Kidney Diseases. Updated September, 2021. https://www.niddk.nih.gov/health-information/health-statistics/overweigh.... Accessed December 20, 2022.
    1. Kolotkin RL, Andersen JR. A systematic review of reviews: exploring the relationship between obesity, weight loss and health-related quality of life. Clin Obes. 2017;7(5):273–89. doi: 10.1111/cob.12203. - DOI - PMC - PubMed
    1. Wang YC, Pamplin J, Long MW, Ward ZJ, Gortmaker SL, Andreyeva T. Severe obesity in adults cost state medicaid programs nearly $8 billion in 2013. Health Aff (Millwood) 2015;34(11):1923–31. doi: 10.1377/hlthaff.2015.0633. - DOI - PubMed
    1. Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity and severe obesity among adults: United States, 2017–2018. NCHS Data Brief. 2020;360:1–8. - PubMed
    1. Sturm R. Increases in morbid obesity in the USA: 2000–2005. Public Health. 2007;121(7):492–6. doi: 10.1016/j.puhe.2007.01.006. - DOI - PMC - PubMed

Publication types

LinkOut - more resources