Network Meta-Analysis of Metabolic Surgery Procedures for the Treatment of Obesity and Diabetes

Abstract

Background Metabolic surgery is part of a well-established treatment intensification strategy for obesity and its related comorbidities including type 2 diabetes (T2DM). Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG) and one-anastomosis gastric bypass (OAGB) are the most commonly performed metabolic surgeries worldwide, but comparative efficacy is uncertain. This study employed network meta-analysis to compare weight loss, T2DM remission and perioperative complications in adults between RYGB, SG and OAGB. Methods MEDLINE, EMBASE, trial registries were searched for randomised trials comparing RYGB, SG and OAGB. Study outcomes were excess weight loss (at 1, 2 and 3–5 years), trial-defined T2DM remission at any time point and perioperative complications. Results Twenty randomised controlled trials were included involving 1803 patients investigating the three metabolic surgical interventions. RYGB was the index for comparison. The excess weight loss (EWL) demonstrated minor differences at 1 and 2 years, but no differences between interventions at 3–5 years. T2DM remission was more likely to occur with either RYGB or OAGB when compared to SG. Perioperative complications were higher with RYGB when compared to either SG or OAGB. Two-way analysis of EWL and T2DM remission against the risk of perioperative complications demonstrated OAGB was the most positive on this assessment at all time points. Conclusion OAGB offers comparable metabolic control through weight loss and T2DM remission to RYGB and SG whilst minimising perioperative complications. Registration number: CRD42020199779 (https:// www.crd.york.ac.uk/PROSPERO ) Graphical abstract

Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

“…Metabolic surgery should be considered as a treatment option in adults with type 2 diabetes who are appropriate surgical candidates (127,132). Metabolic surgery also appears to be effective for diabetes remission in people with type 2 diabetes and a BMI $25 kg/m 2 , although efficacy for both weight loss and diabetes remission appears to vary by surgical type (133)(134)(135). One mixed-effects meta-analysis model has estimated a 43% diabetes remission rate (95% CI 34%, 53%) following metabolic surgery in people with type 2 diabetes and a BMI <30 kg/m 2 (136), significantly higher than that achieved with traditional medical management (137).…”

Nutritional Status after Roux-En-Y (Rygb) and One Anastomosis Gastric Bypass (Oagb) at 6-Month Follow-Up: A Comparative Study

“…OAGB has been widely demonstrated to be non-inferior to RYGB in terms of weight loss and in comorbidity remission [ 9 ]. Furthermore, although 90 days mortality is similar to RYGB, the overall complications rate seems to be significantly reduced [ 10 , 11 ]. Nonetheless, enthusiasm for OAGB is restrained by some disquieting reports indicating a high incidence of postoperative malnutrition and its consequences (in some cases particularly severe) [ 12 , 13 , 14 ].…”

Metabolic bariatric surgery as a therapeutic option for patients with type 2 diabetes: A meta‐analysis and network meta‐analysis of randomized controlled trials

“…Several previous meta‐analyses have been published: some compared the efficacy and safety of some of the available surgical procedures, 3–5 while others focused only on certain aspects (e.g. safety, subgroups of patients), 6–9 or on some endpoints 10 . Other meta‐analyses had similar inclusion criteria and endpoints, but did not include more recently published randomized trials 11–13 …”

“…safety, subgroups of patients), [6][7][8][9] or on some endpoints. 10 Other meta-analyses had similar inclusion criteria and endpoints, but did not include more recently published randomized trials. [11][12][13] The indication of MBS in patients with T2D reported by main international guidelines 1,2 is based on evidence deriving from heterogeneous sources (i.e.…”