Journal Watch—November 2015

| November 1, 2015

A quick look at the noteworthy articles in bariatric and metabolic research


Self-harm emergencies after bariatric surgery: A population-based cohort study.
Bhatti JA, Nathens AB, Thiruchelvam D, Grantcharov T, Goldstein BI, Redelmeier DA. JAMA Surg. 2015 Oct 7:1–7. [Epub ahead of print]
Importance: Self-harm behaviors, including suicidal ideation and past suicide attempts, are frequent in bariatric surgery candidates. It is unclear, however, whether these behaviors are mitigated or aggravated by surgery.
Objective: To compare the risk of self-harm behaviors before and after bariatric surgery.
Design, Setting, and Participants: In this population-based, self-matched, longitudinal cohort analysis, we studied 8815 adults from Ontario, Canada, who underwent bariatric surgery between April 1, 2006, and March 31, 2011. Follow-up for each patient was 3 years prior to surgery and 3 years after surgery.
Main Outcomes and Measures: Self-harm emergencies 3 years before and after surgery.
Results: The cohort included 8815 patients of whom 7176 (81.4%) were women, 7063 (80.1%) were 35 years or older, and 8681 (98.5%) were treated with gastric bypass. A total of 111 patients had 158 self-harm emergencies during follow-up. Overall, self-harm emergencies significantly increased after surgery (3.63 per 1000 patient-years) compared with before surgery (2.33 per 1000 patient-years), equaling a rate ratio (RR) of 1.54 (95% CI,1.03-2.30; P=.007). Self-harm emergencies after surgery were higher than before surgery among patients older than 35 years (RR,1.76; 95% CI,1.05-2.94; P = .03), those with a low-income status (RR,2.09; 95% CI,1.20-3.65; P = .01), and those living in rural areas (RR,6.49; 95% CI,1.42-29.63; P = .02). The most common self-harm mechanism was an intentional overdose (115 [72.8%]). A total of 147 events (93.0%) occurred in patients diagnosed as having a mental health disorder during the 5 years before the surgery.
Conclusions and Relevance: In this study, the risk of self-harm emergencies increased after bariatric surgery, underscoring the need for screening for suicide risk during follow-up.
PMID: 26444444

Monitoring of diabetic retinopathy in relation to bariatric surgery: a prospective observational study.
Brynskov T, Laugesen CS, Svenningsen AL, Floyd AK5, Sørensen TL. JAMA Surg. 2015 Sep 16:1-8. [Epub ahead of print]
Synopsis: Background: To investigate the need for closer perioperative monitoring of diabetic retinopathy in patients with type 2 diabetes undergoing bariatric surgery.
Methods: Prospective observational clinical study of 56 patients with type 2 diabetes undergoing bariatric surgery. The patients were examined with 7-field fundus images and optical coherence tomography scans 2 weeks before and 1, 3, 6 and 12 months after bariatric surgery. Worsening was defined as a two-step change in the Wisconsin Epidemiologic Study of Diabetic Retinopathy scale or appearance or worsening of macular edema. Postoperative changes were analyzed in a mixed model.
Results: Six patients (11 %) had any worsening at any visit, and three (5 %) persisted at 1 year. Of the 24 patients with preoperative retinopathy, 4-13 % worsened and 9-22 % improved, with significant overall improvement at 6 months (p=0.01). Only one (3%) of the 32 patients without preoperative diabetic retinopathy had a transient worsening at 6 months. No patients developed macular edema, but the whole cohort had a minor increase in center point foveal thickness that peaked 6 months postoperatively. The patients were required to have good glucose control preoperatively where HbA1c was 6.4±1.9 %.
Conclusions: Diabetic retinopathy was clinically stable after bariatric surgery, and none of the observed changes would have resulted in a changed screening interval at our center. This supports adherence to regular diabetic retinopathy screening guidelines following bariatric surgery in well-controlled patients. A clinically negligible but statistically significant foveal thickening 6 months postoperatively warrants further study.
PMID: 26476835

Wernicke Encephalopathy: A future problem even after sleeve gastrectomy? A systematic literature review.
Kröll D, Laimer M, Borbély YM, Laederach K, Candinas D, Nett PC.
Synopsis: Wernicke encephalopathy (WE) is a serious complication of bariatric surgery with significant morbidity and mortality. A few cases have been reported in the literature, mainly in patients after a Roux-en-Y gastric bypass. Since sleeve gastrectomy (SG) has become a more established and popular bariatric procedure, WE is expected to appear more frequently after SG. The authors performed a literature review on WE after SG, and 13 cases have been found to be sufficiently documented. They conclude that the risk of WE needs to be considered in patients with a prolonged vomiting episode and any type of neurological symptoms, independent of the presence of any surgical complications.
PMID: 26476834

Taste and olfactory changes following laparoscopic gastric bypass and sleeve gastrectomy.
Zerrweck C, Zurita L, Álvarez G, Maydón HG, Sepúlveda EM, Campos F, Caviedes A, Guilbert L. Obes Surg. 2015 Oct 16. [Epub ahead of print]
Synopsis: Background: Alterations in taste/smell after bariatric surgery have been observed, but few data is available. Some authors documented these changes and their role on weight loss but there is no evidence after laparoscopic sleeve gastrectomy (LSG). Methods: Cohort study with patients submitted to laparoscopic gastric bypass (LGBP) and LSG that were asked to participate in a validated survey. The primary objective was to determinate the differences between procedures for taste and smell changes; a demographic and anthropometric analysis were also performed. Secondarily, the relation between food aversion and weight loss was also obtained. Results: Final analysis was based on 154 patients (104 LGBP and 50 LSG). The overall mean time between surgery and questionnaire was 10±6.7 months. Most of the patients (87.6 %) experienced some taste/smell change. There were no differences between procedures for any change, taste or smell change. More patients submitted to LGBP referred that food smelled different (51.9 vs 34 % for the LSG group; p=0.040). Higher %EWL was observed for patients presenting food aversion (73.3±19.7 vs 65.8±19.4 % for those without aversion; p=0.046). Based on type of surgery, the LGBP group had the same trend (%EWL of 78.2±17.3 vs 70.4±18.6 % for those without aversion; p=0.044). Conclusion: The majority of patients presented taste and olfactory changes soon after surgery independently of type of procedure. Patients submitted to LGBP referred more often a different smell in food. Higher %EWL was observed in patients presenting any food aversion, especially in the LGBP group.
PMID: 26475030

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