Recent Study comparing DS to GB

Hi all,

FYI. I came across this summary of the study and noted the editorial comment about the DS.  I was not able to get the editorial but the abstract looked favorable or at least neutral to the DS so I was surprised by the editorial comment.

Duodenal Switch Surgery Riskier Than Gastric Bypass

The first randomized comparison of gastric bypass and duodenal switch surgery, published in the Annals of Internal Medicine, shows greater weight loss and improvements in cardiovascular risk factors with duodenal switch, but at the expense of more adverse events.

Two years after gastric bypass or duodenal switch was performed on some 60 patients with superobesity (BMI, 50 to 60), most cardiovascular risk factors improved in both groups. Duodenal switch patients had greater weight loss than bypass patients (mean loss, 74 vs. 51 kg), as well as greater reductions in total and LDL cholesterol. However, they also had more adverse events (62% vs. 32%); in particular, malnutrition-related events such as night blindness, severe iron deficiency, and protein calorie deficiency occurred only after duodenal switch.

An editorialist notes that few patients had adverse cardiovascular profiles to begin with and concludes: "We should seriously question whether there is any role for the duodenal switch operation ... its complications are very real and very severe."

Annals of Internal Medicine article (Free abstract)

Annals of Internal Medicine editorial (Subscription required)

This actually doesn't suprise me too much.  Seems that many people don't consider that adequate aftercare is almost as important as the cutting with the Duodenal Switch.
With the inadequate and even dangerous diet advice post-op DSers get, like a chewable multivitamin is good enough, it doesn't suprise me that there are negative outcomes.
BUT - these deficiencies are normally preventable with correct supplementation.  I'm not sure you can blame it on the surgery itself rather than the crappy surgical aftercare and ignorance about what DS patients need to stay healthy.

I bet if they compared post-op patients that were correctly advised of their new nutritional needs, the DS would come out as clearly superior to the GB result wise.

I feel so sorry for those DS patients who don't know about this website or have access to the proper info.

It seems to me that the fact is that people who get the DS WILL die or get very sick if they follow their doctor's or nutritionalist's orders.  The professionals that I have encountered have absolutely no knowledge of the DS or the required supplementation or diet.  Really, I think that those who are right for this procedure are people who are go-getters, we fight for the surgery, we sudy all we can about it, and we find our OWN resources so that we can be successful.  That's why I don't spread the word about it too lightly. I don't want every Tom, Dick and Harry coming out and asking for it unless they're willing to do the work to research it themselves because if they follow what the average doc says, they probably won't live very long.  I recently shared my DS story with a wana-be sleeve patient, but I told her the good, the bad and the ugly (as I have been told myself)--then I sent her to DSfacts.com and then to the OH website.  If she doesn't do the research herself, then she's definitely not right for this procedure.

I just wish we had better educated medical professionals out there to help us out a bit more.

Sher-

The fact that you know this is why you are going to be an awesome DSer once you have finished doing the Kaiser approval dance. 

I personally think if you aren't smart enough to do research, regardless of which bariatric surgery you are interested in having, you should no be able to have it.

Thanks. I'm still learning, but I figure this is all part of the process--lifelong learning and adjustment.

Smiles,

Sher-

I have a copy of that study and just read it.  It's interesting, but the study is very small.  The side effects were mostly hepatic and vitamin deficiencies on the DS side.  Interestingly though, they were only given the following for supplementation:

All participants were prescribed daily supplements of
multivitamins, 100 mg of iron sulfate, 1000 mg of calcium
carbonate, and 20 mcg of vitamin D3. In addition, participants
in the gastric bypass group received a vitamin B12
substitute. Ursodeoxycholic acid was prescribed for 6
months, except in participants who had had cholecystectomy.
Participants were seen by a dietitian and surgeon at
inclusion and at 6 weeks, 6 months, 1 year, and 2 years
after surgery. The dietitian visits included a dietary recall
and evaluation of nutritional status and adherence to vitamin
supplementation. Participants received top-up supplementation
according to predefined cutoff levels of vitamin
concentrations (23).

That seems really low, expecially the Vitamin D3.  That's only 800 IU.  I take 15,000 a day now and I'm pre-op. 

I'd be interested to hear what some of the vets think of this study.

So...they didn't properly supplement them and they blamed the surgery for the malnutrition? Geniuses, these guys.

Curious to know if they used the dry form of vitamins. Otherwise might as well give them nothing. Top-up supplementation suggests that they were allowed to increase their vitamins based on labs. Was there a breakdown of doses and a high and low range for vitamin doses? Did they provide the average level of protein ingested daily? Sorry for the questions but these are things to consider.

I am not a vet but as a health care professional I call big piles of BS on this one and would not let it sway me in my decision. My surgeon requires appointments (and labs) at 4 weeks, 3 months, 6 months, 9 months, 12 months, 18 months, 24 months, then yearly thereafter. Further, elevated LFTs is a result of weight loss and will likely resolve on its on. Vitamin deficiencies are treatable as well.

Do you know who authored the editorial? I didn't recognize the name of the any of the authors for the study. My guess is some of the well known DS surgeons will provide a rebuttal. But that won't likely get any press.

As a reviewer of exactly such articles - editorials especially - I can tell you that:

1.editorials really do not carry that much importance - they add to an author's resume of published material but are not cited as research articles.

2.the original article is pretty "thin" in content value because of the statistically insignificant number of patients studied - very low number actually,
the relatively reduced number of parameters observed,
the extremely short time of observation;
as well as the low number of resources cited in support of their observations (medication especially is very hard to quantify in outpatient cir****tances and rely on the patients' own words.)