Nutrient Status 9 Years After Biliopancreatic Diversion with Duodenal Switch (BPD/DS): an Observational Study

Abstract

Major deficits in nutrient status occurred and persisted after surgery although supplementation was prescribed. Interventions are mandated to avoid nutrient deficiency.

Duodenal switch in revisional bariatric surgery: conclusions from an expert consensus panel

“…In a systematic review of 48 studies and 1,565 patients undergoing bariatric procedures, BPD/DS was associated with 73% excess body weight loss (EBWL) at 2 years, ahead of RYGB (63%), gastroplasty (56%), and laparoscopic adjustable gastric banding (LAGB) (49%) (8,a) . These results have been replicated in patients with BMI ≥ 50, where BPD/DS was superior to RYGB in maximizing weight loss up to 9 years following surgery (4,9,10,11) .…”

Malnutrition secondary to gastrojejunal stricture after biliopancreatic diversion

“…It is one of the most effective surgical procedures for obesity, with an overall 5-year loss of excess body weight higher than 72% [ [1] , [6] , [7] ]. Nonetheless, it is associated with long-term complications such as protein malnutrition and vitamin deficiencies due to malabsorption [ [5] , [11] , [12] ], especially in patients who are not monitored closely. Protein malnutrition can occur in 7.7–11.9% BPD patients and when gastric pouch is smaller than 200 mls – even in 17.8% [ 11 ].…”

“…Scopinaro describes 1,2% of intestinal obstruction rate and 11.9% protein malnutrition rate in his large series with a follow-up of 18 years. Despite regular use of supplements, up to 94% of the patients may present with vitamin (especially fat-soluble) and mineral deficiencies [ [12] , [13] ]. Iron deficiency anaemia occur in approximately 60% of patients undergoing BPD and is caused by diminished secretion of stomach acids and the exclusion of the duodenum and proximal jejunum.…”

Cholecalciferol Injections Are Effective in Hypovitaminosis D After Duodenal Switch: a Randomized Controlled Study

“…The BPD/DS surgery is an effective weight loss procedure because of its two working mechanisms: reduced intake and reduced absorption of ingested nutrients. The uptake of fat-soluble substances can only occur in the most distal 100 cm of the distal ileum (common limb), after mixing with bile, making BPD/DS the most malabsorptive bariatric procedure [ 24 ]. Moreover, the bypass of the duodenum, which has the highest density of vitamin D receptors, results in reduced effect of oral vitamin D supplements [ 25 ].…”