DDW 2009: Duodenal Switch Significantly Reduces Comorbidities of Superobesity

Martha Kerr

June 08, 2009

June 8, 2009 (Chicago, Illinois) — A duodenal switch (DS) procedure for the morbidly obese "provides superior resolution of diabetes, hypertension, and dyslipidemia . . . in the superobese, independent of weight loss," compared with Roux-en-Y gastric-bypass surgery, Chicago gastroenterologists reported here at Digestive Disease Week 2009.

The DS procedure involves a partial gastrectomy along the greater curvature, keeping the pyloric valve intact, and diverts part of the duodenum to maximize digestion of food by the stomach and minimize nutrient loss.

Results of more than 3 years of follow-up data comparing outcomes in 198 patients undergoing DS and 152 patients undergoing gastric-bypass surgery were presented by Vivek N. Prachand, MD, assistant professor of surgery at the University of Chicago Medical Center in Illinois.

Patients in the study had a minimum body mass index of 50 kg/m2. Incidence and severity of hypertension, dyslipidemia, and gastroesophageal reflux disease (GERD) were comparable in both groups. Diabetes was less common but more severe in the DS group than in the gastric-bypass group (24.2% vs 35.5%; P < .05).

At 36 months, diabetes had resolved in 100% of patients in the DS group, compared with 60% of those in the gastric-bypass group. Hypertension resolved in 68.0% of patients in the DS group, compared with 38.6% of those in the gastric-bypass group. Dyslipidemia resolved in 72% of patients in the DS group, compared with 26.3% of those in the gastric-bypass group.

In contrast, GERD resolution occurred in only 48.57% of patients in the DS group, compared with 76.9% of those in the gastric-bypass group (P < .05).

There were no differences in weight loss between comorbidity "resolvers" and "persisters," Dr. Prachand said.

"Resolution of comorbidities, irrespective of weight loss, raises interesting avenues of research," Dr. Prachand told Medscape Gastroenterology, including, among other causes of obesity, the investigation of possible hormones involved with those types of surgery.

"It is not just the fat itself that is involved," he said.

"The [duodenal] switch works via malabsorption, so there is the potential for nutritional deficiencies," Dr. Prachand explained. "One fifth of these patients have vitamin A deficiency and one fifth have vitamin D deficiency."

"There are no well-defined strategies to treat malabsorption, other than with supplements. Many times, these patients will have deficiencies preoperatively," he noted.

"Weight loss is a complex issue with no silver bullet," moderator Robert H. Hawes, MD, professor of medicine from the Medical University of South Carolina in Charleston, said in an interview.

There is a disconnect between weight loss and diabetes and other comorbidities."

"Rates of superobesity, such as the patients in this study, have increased 10-fold, and rates of severe obesity have quadrupled," Dr. Hawes remarked.

Dr. Prachand has disclosed no relevant financial relationships. Dr. Haws receives consulting fees from Apollo Endosurgery Inc, Boston Scientific, and Cook Endoscopy.

Digestive Disease Week (DDW) 2009: Abstract 459. Presented June 2, 2009.

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