COMMENTARY

Gastric Bypass vs Conventional Medical Therapy for Metabolic Syndrome

Albert B. Lowenfels, MD

Disclosures

August 16, 2013

Roux-en-Y Gastric Bypass vs Intensive Medical Management for the Control of Type 2 Diabetes, Hypertension, and Hyperlipidemia: The Diabetes Surgery Study Randomized Clinical Trial

Ikramuddin S, Korner J, Lee WJ, et al
JAMA. 2013;309:2240-2249

Summary

How does Roux-en-Y gastric bypass compare with conventional medical therapy for the management of patients with metabolic syndrome? The authors randomly assigned 120 patients to either lifestyle management measures or surgery plus lifestyle management. Average age was 49 years, and about 60% of patients were female. Body mass index in both groups was similar. At the end of a year, 19% of patients in the lifestyle group had satisfactory control of diabetes, hypertension, and hyperlipidemia compared with 49% of patients in the surgical group. Weight loss was also greater in the surgical group than in the medical group. Serious adverse events included 2 anastomotic leaks, which led to organ failure in 1 patient and eventual leg amputation prior to discharge.

Viewpoint

This randomized trial provides evidence that bypass surgery provides better initial results in the management of patients suffering from metabolic syndrome than conventional medical therapy. Serious complications were more frequent in the surgical group, which included 2 patients with anastomotic leaks. Only 5% of the 2648 subjects initially assessed for the study were eventually enrolled, implying that the results may not be applicable to other patients. The results cover only a 1-year follow-up period, which is much less than the anticipated life expectancy of the patients included in the study. It will be important to observe the outcome of these patients after a longer period of follow-up.

Abstract

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