Comparison of single-anastomosis gastric bypass and sleeve gastrectomy on type 2 diabetes mellitus remission for obese patients: A meta-analysis of randomized controlled trials

Mar 31, 2023Asian journal of surgery

Comparison of two weight-loss surgeries on type 2 diabetes remission in obese patients: A review of clinical trials

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Abstract

The remission of type 2 diabetes mellitus (T2DM) was more efficient in the one anastomosis gastric bypass (OAGB) group at both 1 year and 5 years compared to sleeve gastrectomy (SG).

OAGB showed greater improvements in hypertension and fasting plasma glucose compared to SG.
At 1 year, OAGB demonstrated a notable percentage of excess body mass index loss (%EBMIL) that was not significant at 6 months.
Five years post-surgery, OAGB resulted in a higher percentage of excess weight loss (%EWL) than SG.
At 5 years, the OAGB group had a lower body mass index (BMI) compared to the SG group, although differences at 6 months and 1 year were not significant.
At 6 months, OAGB exhibited a more remarkable percentage of total weight loss (%TWL) compared to SG.
In general, OAGB is associated with better outcomes for T2DM, hypertension, and weight loss than SG in the medium-term follow-up.

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Currently, the increasing numbers of one anastomosis gastric bypass (OAGB) brought this technique in the third position in order of frequency, behind sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). However, OAGB is still considered lack of evidence in reducing obesity- related comorbidities. Our study aimed to compare the efficacy for SG and OAGB improving type 2 diabetes mellitus (T2DM) remission and weight loss in obese patients. PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for randomized controlled trials (RCTs) comparing OAGB and SG. Review Manager 5.4.1 was used to analyze the data, and the right effect model was chosen based on heterogeneity. Five randomized controlled trials were included in the study. The remission of T2DM in the OAGB group was more efficient at 1 year and 5 years. Meanwhile, the OAGB group has a greater improvement than the SG group in terms of hypertension (HTN) and fasting plasma glucose (FPG). Although the percentage of excess BMI loss (%EBMIL) between the OAGB and SG groups was not significant at 6 months, the OAGB group had a conspicuous %EBMIL at 1 year. And 5 years after surgery, a higher percentage of excess weight loss (%EWL) was found in the OAGB group. Besides, the OAGB group showed a lower body mass index (BMI) at 5 years than the SG group, but the BMI at 6 months and 1 year were not significant. Finally, at 6 months, the OAGB group exhibited a more remarkable percentage of total weight loss (%TWL) than the SG group. In general, OAGB exhibited a better therapeutic effect in T2DM, HTN, and weight loss than SG in the medium-term follow-up period. To assess the long-term efficacy, clinics should be encouraged to continue longer-term follow-up studies and possibly RCTs.

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Comparison of single-anastomosis gastric bypass and sleeve gastrectomy on type 2 diabetes mellitus remission for obese patients: A meta-analysis of randomized controlled trials

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