TOPLINE

In a randomized pilot trial of patients with obesity, combining transit bipartition with sleeve gastrectomy (SG) was associated with a significantly lower incidence of new-onset gastroesophageal reflux disease (GERD) at 12 months compared with SG alone. The procedure, which connects the stomach to the lower small intestine and is designed to ease intragastric pressure, was also associated with greater weight loss.

METHODOLOGY

• SG is the world’s most performed weight-loss operation, but it can trigger acid reflux in up to 40% of patients, prompting surgeons to test modifications such as transit bipartition.
• Researchers conducted a randomized clinical trial to compare the incidence of new-onset GERD and weight loss after SG with or without transit bipartition in 120 patients with obesity.
• Patients were randomly assigned to either the standard SG group (n = 60; mean age, 43.5 years; 76.7% women) or the SG plus transit bipartition group (n = 60; mean age, 44.1 years; 78.3% women).
• Participants were included if they had a BMI ≥ 40, a BMI ≥ 35 with at least one obesity-related complication, or a BMI ≥ 30 with inadequately controlled type 2 diabetes (T2D); those with severe baseline reflux or esophagitis grade C or D on preoperative endoscopy were excluded.
• The primary outcome was a composite measure of new-onset GERD at 12 months, met if a patient had abnormal esophageal acid exposure (> 6% of the monitoring period), symptomatic reflux requiring continuous proton pump inhibitor therapy, or erosive esophagitis of any severity.

TAKEAWAY

• At 12 months, the SG plus transit bipartition group had a significantly lower incidence of new-onset GERD than the SG group (3.3% vs 28.3%; P < .001); patients in the SG plus transit bipartition group also reported fewer symptoms (P < .001) and used proton pump inhibitors less often (P = .002).
• SG plus transit bipartition was associated with a significantly greater weight loss, both in terms of percentage of total weight loss (34.8% vs 30.2%; P < .001) and percentage of excess weight loss (78.5% vs 71.2%; P = .002).
• Among the 42 participants with T2D at baseline, remission rates were numerically higher after SG plus transit bipartition than after SG, though this difference did not reach statistical significance. Mean A1c levels were significantly lower in the SG plus transit bipartition group vs SG group (P = .006).
• SG plus transit bipartition required a longer mean operative time than SG (122 vs 75 minutes), but the duration of hospital stay, 30-day complication rates, and 12-month nutritional markers were comparable between the two groups.

IN PRACTICE

"This result challenges the widespread practice of performing SG without fully addressing the inherent risk of reflux and positions SG-TB [sleeve gastrectomy with Roux-en-y transit bipartition] as a physiologically more advantageous alternative, particularly for a selected patient population," the authors wrote.

"[It] must be emphasized that for patients with significant pre-existing GERD, Barrett's esophagus, or severe esophagitis, Roux-en-Y Gastric Bypass (RYGB) remains the gold-standard bariatric procedure, and the procedure of choice in our own clinical practice," they added.

SOURCE

This study was led by Vincenzo Consalvo, Clinica San Gaudenzio, Novara, Italy. It was published online in Obesity Surgery.

LIMITATIONS

The study excluded patients with severe preexisting GERD (grade C or D esophagitis). As follow-up lasted only 12 months, the long-term durability of weight loss, reflux control, and nutritional status remained unknown. In addition, the subgroup of patients with mild preexisting GERD was small.

DISCLOSURES

No funding information was provided for this study. The authors reported no relevant competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.