Life Flies

Five-Year Bariatric Surgery Outcomes Impress

Five-year bariatric surgery outcomes from the STAMPEDE randomized controlled trial are nothing short of impressive. Philip Schauer presented the results in a late-breaking session at the American College of Cardiology Annual Scientific Session in Chicago.

Our findings show continued durability of glycemic control after metabolic surgery, as well as persistent weight loss, reduction in diabetes and cardiovascular medications at five years. Some advantages of gastric bypass over sleeve gastrectomy have emerged during follow-up. At 5 years, gastric bypass maintained greater weight loss than sleeve gastrectomy while requiring fewer medications.

Most clinical guidelines and insurance policies for bariatric surgery limit access to patients with a BMI of 35 or above. Our 5-year results demonstrate that glycemic improvement in patients with a BMI of 27 to 34 is durable at least up to 5 years.

The STAMPEDE  trial is the largest randomized trial with one of the longest comparing medical therapy with bariatric surgery. Of 150 patients with BMI of 27 and higher and poorly-controlled diabetes, 50 received intensive medical therapy only, including counseling and medications. The remaining 100 patients were divided evenly between Roux-en-Y gastric bypass surgery and sleeve gastrectomy.

In bariatric surgery patients, 88 percent maintained acceptable blood glucose levels. A1c levels below 6% were achieved and maintained by 29% of bypass patients, 23% of sleeve patients, and only 5% of medically managed patients. The one late surgical complication that Schauer reported was a recurrent gastric fistula that required reoperation to convert a gastric sleeve to a gastric bypass.

Endocrinologist and co-investigator Sangeeta Kashyap put the findings into perspective:

Left unchecked, diabetes can lead to kidney failure, blindness, and limb amputation. At the five-year mark, bariatric surgery’s metabolic effect persists and is more effective at treating type 2 diabetes in moderate and severely obese patients when compared to medical therapy. The superior benefits of surgery to attain diabetes treatment goals must be carefully balanced with the long-term risks associated with surgery for individual patients.

Results from this and other studies like it are driving a slow movement toward more and earlier consideration of bariatric surgery to bring type 2 diabetes under control and prevent its complications.

Click here to read more from AMJC, here to read more from MedicalXpress, and here to read the 3-year results published in NEJM.

Life Flies, photograph © Thomas Hawk / flickr

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April 6, 2016