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Promote or delay the Gastric Bypass?



Obese people were severely obese and weighed an average of 147 kg (324 pounds) around 38 kg (84 pounds) lighter 5 years after they had bariatric surgery – and puberty was more likely to be get rid of diabetes and hypertension, a new study reveals.

On the other hand, adolescents were also more likely to have iron deficiency, need abdominal reopening, or die through drug overdose (although this is very rare).

So, whether obese teenagers should have gastric avoidance surgery while they are still puberty or postponed until later, that's dependent on the t individual patient, said one expert.

Results published for Childhood Obesity Summit in Houston

The new findings, by Thomas H. Inge, MD, PhD, University of Colorado, Denver and Children's Hospital, Aurora, and colleagues, are based on a comparison of results after gastric bypass Roux-en-Teens in the Teen- Longitudinal Assessment of Bariatric Surgery (Teen-LABS) against adults in the LABS study.

"We have recorded similar and durable weight loss after gastric bypass in adolescents and adults, but observed important differences between these cohorts in specific health outcomes," they summarized in their article published online May 16 in the New England Journal of Medicine to accompany the summit Going to Childhood Obesity Tackle in Houston, Texas.

In this study, and one similar by Olbers and colleagues (Endocrinal Diabetes Lancet. 2017; 5: 174-183), "the data 5 years [for gastric bypass in very obese teens] looks promising but … the result is unknown, "Ted D. Adams, PhD, MPH, Intermountain Healthcare and the University of Utah, Salt Lake City, warned in an associated editorial.

Inge and colleagues agree that "further long-term follow-up and research will be important in refining the risks and benefits of bariatric surgery in young people."

Meanwhile, Adams advises, "the decision to recommend bariatric surgery for young people with severe obesity or to postpone the operation into adulthood … t[needs to be] after careful consideration of harm and associated benefits. "

Young people may not be able to make an informed decision about weight loss surgery, it states.

"For now," Adams comes to the conclusion, "although we hope to identify new, effective and less intrusive therapies and effective links to bariatric surgery in adolescence (ie the integration of pharmacotherapy and multi-specialty lifestyle). ), decisions should be made on a case-by-case basis.

Young people are more likely to be released from diabetes, hypertension

Bariatric surgery, effective for treating severe obesity in adults, is most commonly performed in patients in their 30s or 40s, the authors explain.

But it is not clear whether young people with severe obesity should have this operation or wait until they are older.

This issue is becoming increasingly important, Adams is writing, as nearly 6% of young people in the United States are seriously obese (body mass index) t [BMI] ≥ 35 kg / m2).

In order to investigate this, researchers identified that 161 young people were obese in the Teen-LABS study aged between 13 and 19 (17 year olds) when they received the Roux-en-Y gastric bypass at five centers in 2006-2012.

This cohort was compared with 396 obese adults in LABS who had been obese at the age of 18 and had a gastric bypass at 25-50 years (mean age, 38) in 10 centers in 2006-2009.

Participants in the two BMI groups had a mean of 50 kg / m2 when they had the bariatric surgery and 77% were women.

Five years after surgery, adolescents and adults had lost a similar amount of their initial weight, 26% and 29%, respectively.P = .08).

However, the rate of diabetes decreased more among young people than adults (from 14% to 2.4% compared to 31% to 12%).

Similarly, the incidence of hypertension increased amongst young people than adults (from 30% to 15% compared to 61% to 39%).

Compared to adults, adolescents were much more likely to have diabetes removed (86% compared to 53%; risk ratio, 1.27) and high blood pressure (68% of; compared to 41%, risk ratio, 1.51).

Drug Overdoses Only Worrisome

The mortality rate during the five year sequence was similar in both groups – three adolescents (1.9%) and seven adults (1.8%) died – but the cases were different.

Teenagers died of drug overdose (two patients) and sepsis following hypoglycemia (one patient with type 1 diabetes).

The adult died of gastric bypass (three patients) cases, unspecified cases (two), suicide (one), and colon (one) cancer.

"Although the 5-year mortality rates are similar in both groups," Adams writes, "he is worried that there is a cause of death in two of the three puberty t [who died] consistent with overdose. "

This is a "depressing" perception, Inge and colleagues agree, "given the increasing trend of drug overdose deaths in the United States, and in the light of the increased risk of substance and alcohol use disorders in adults after Gastric bypass surgery. "

"Indeed," they continue, "despite the small number of people who have been affected by overdose so far after gastric bypass surgery, these findings may indicate the need for more specific research efforts, education. patients, and predictable guidelines. "

In addition, although fritritin levels assume normal in 98% of adolescents and adults, by 2 years after the operation many more young people than adults had low levels of pharmaceuticals (48% of them). compared with 29%; P = .004).

In addition, during the 5 year follow-up work, more young people than adults had abdominal operations (20% compared to 16%), mostly cholecystectomy, and less surgery t for bowel obstruction, hernia repair, or gastrostomy.

Recently, the Teen-LABS study began continuously registering teenagers with our sleeve gastrectomy.

The Teen-LABS consortium is supported by the National Institute for Diabetes and Digestion and Renal Diseases. The authors have not reported any relevant financial relationships.

N Engl J Med. Published online May 16, 2019. Abstract, Editorial

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