Gastric Bypass better than Sleeve Gastrectomy for 10-Year Outcomes: JAMA

Long-term results from randomized clinical trials comparing laparoscopic sleeve gastrectomy (LSG) with laparoscopic Roux-en-Y-gastric bypass (LRYGB) are limited.

A study was conducted to compare long-term outcomes of weight loss and remission of obesity-related comorbidities and the prevalence of gastroesophageal reflux symptoms (GERD), endoscopic esophagitis, and Barrett esophagus (BE) after laparoscopic sleeve gastrectomy and LRYGB at 10 years.

This 10-year observational follow-up evaluated patients in the Sleeve vs Bypass (SLEEVEPASS) multicenter equivalence randomized clinical trial comparing laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y-gastric bypass in the treatment of severe obesity in which 240 patients aged 18 to 60 years with median body mass index of 44.6 were randomized to laparoscopic sleeve gastrectomy (n = 121) or laparoscopic Roux-en-Y-gastric bypass (n = 119). The initial trial was conducted from April 2008 to June 2010 in Finland, with last follow-up on January 27, 2021.

Results:

• At 10 years, of 240 randomized patients, 2 never underwent surgery and there were 10 unrelated deaths; 193 of the remaining 228 patients (85%) completed follow-up on weight loss and comorbidities, and 176 of 228 (77%) underwent gastroscopy.
• Median (range) %EWL was 43.5% after laparoscopic sleeve gastrectomy and 50.7% after laparoscopic Roux-en-Y-gastric bypass.
• Mean estimate %EWL was not equivalent between the procedures; %EWL was 8.4 higher in LRYGB.
• After laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y-gastric bypass, there was no statistically significant difference in type 2 diabetes remission, dyslipidemia or obstructive sleep apnea.
• Hypertension remission was superior after LRYGB.
• Esophagitis was more prevalent after laparoscopic sleeve gastrectomy with no statistically significant difference in BE.
• The overall reoperation rate was 15.7% for LSG and 18.5% for laparoscopic Roux-en-Y-gastric bypass.

Thus, at 10 years, %EWL was greater after laparoscopic Roux-en-Y-gastric bypass and the procedures were not equivalent for weight loss, but both laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y-gastric bypass resulted in good and sustainable weight loss. Esophagitis was more prevalent after laparoscopic sleeve gastrectomy, but the cumulative incidence of Barrett esophagus was markedly lower than in previous trials and similar after both procedures.

Reference:

Salminen P, et al "Effect of laparoscopic sleeve gastrectomy vs Roux-en-Y gastric bypass on weight loss, comorbidities, and reflux at 10 years in adult patients with obesity: the SLEEVEPASS randomized clinical trial" JAMA Surgery 2022.

DOI: 10.1001/jamasurg.2022.2229

Keywords:

Salminen P, Effect, laparoscopic, sleeve, gastrectomy, Roux-en-Y, gastric, bypass, weight loss, comorbidities, reflux, 10 years, adult, patients, obesity, SLEEVEPASS, randomized, clinical trial, JAMA Surgery, Sofia Grönroos, Mika Helmiö, Saija Hurme, Anne Juuti, Risto Juusela, Pipsa Peromaa-Haavisto, laparoscopic sleeve gastrectomy, Barrett esophagus, gastroesophageal reflux symptoms