Efficacy of Roux-en-Y Gastric Bypass for Obesity and Its Comorbidities: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 DURun-yu ,  HANPing

Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang 110004, China;

Corresponding author：

HANPing, Email: hanping85@hotmail.com

Keywords：

Roux-en-Y gastric bypass; Obesity; Type 2 diabetes mellitus; Cardiovascular disease; Meta-analysis

DOI：

10.7507/1672-2531.20140217

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Objective To systematically review the efficacy of Roux-en-Y gastric bypass for obesity and its comorbidities. Methods Such databases as PubMed, EMbase, The Cochrane Library (Issue 11, 2013), CBM, CNKI, VIP and WanFang Data, etc. were electronically searched from inception to November 2013, for including all studies on Roux-en-Y gastric bypass for obesity and its comorbidities. According to inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and evaluated methodological quality of included studies. And then meta-analysis was performed using RevMan 5.3 software. Results A total of 25 before and after self-control studies involving 2 966 cases with overweight or obesity were included. The results of meta-analysis showed that:after Roux-en-Y gastric bypass operation, the patients had significant reduction in BMI (MD=-16.40, 95%CI-17.42 to-15.38, P < 0.000 01), type 2 diabetes mellitus prevalence (RR=0.23, 95%CI 0.17 to 0.31, P < 0.000 01), and hypertension prevalence (RR=0.34, 95%CI 0.26 to 0.43, P < 0.000 01); besides, fasting glucose, blood pressure and serum lipid levels obviously decreased (P < 0.000 01). Conclusion Roux-en-Y gastric bypass for obesity patients is effective in reducing weight loss, type 2 diabetes mellitus incidence and cardiovascular disease incidence. Due to the limitation of the design of the included studies, the conclusion needs to be verified by further conducting high quality randomized controlled trials with large sample-size.

Citation： DURun-yu, HANPing. Efficacy of Roux-en-Y Gastric Bypass for Obesity and Its Comorbidities: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2014, 14(11): 1343-1350. doi: 10.7507/1672-2531.20140217 Copy

1.	World Health Organization. Obesity and overweight EB/OL updated 2013 Mar. Available at:http://www.cdc.gov/ncidod/EID/htm.
2.	Sjöström L, Gummesson A, Sjöström CD, et al. Effects of bariatric surgery on cancer incidence in obese patients in Sweden (Swedish Obese Subjects Study):a prospective, controlled intervention trial. Lancet Oncol, 2009, 10(7):653-662.
3.	Wells G, Shay B, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analysis. In:Ottawa, 2012; Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
4.	Cowan GS Jr, Buffington CK. Significant changes in blood pressure, glucose, and lipids with gastric bypass surgery. World J Surg, 1998, 22(9):987-992.
5.	Serra A, Granada ML, Romero R, et al. The effect of bariatric surgery on adipocytokines, renal parameters and other cardiovascular risk factors in severe and very severe obesity:1-year follow-up. Clin Nutr, 2006, 25(3):400-408.
6.	White S, Brooks E, Jurikova L, et al. Long-term outcomes after gastric bypass. Obes Surg, 2005, 15(2):155-163.
7.	Bowne WB, Julliard K, Castro AE, et al. Laparoscopic gastric bypass is superior to adjustable gastric band in super morbidly obese patients:a prospective, comparative analysis. Arch Surg, 2006, 141(7):683-689.
8.	Cottam D, Atkinson J, Anderson A, et al. A case-controlled matched-pair cohort study of laparoscopic Roux-en-Y gastric bypass and Lap-Band patients in a single US center with three-year follow-up. Obes Surg, 2006, 16(5):534-540.
9.	Puzziferri N, Austrheim-Smith IT, Wolfe BM, et al. Three-year follow-up of a prospective randomized trial comparing laparoscopic versus open gastric bypass. Ann Surg, 2006, 243(2):181-188.
10.	Alexandrides TK, Skroubis G, Kalfarentzos F. Resolution of diabetes mellitus and metabolic syndrome following roux-en-y gastric bypass and a variant of biliopancreatic diversion in patients with morbid obesity. Obes Surg, 2007, 17(2):176-184.
11.	Anderson WA, Greene GW, Forse RA, et al. Weight loss and health outcomes in African Americans and whites after gastric bypass surgery. Obesity (Silver Spring), 2007, 15(6):1455-1463.
12.	Batsis JA, Romero-Corral A, Collazo-Clavell ML, et al. Effect of weight loss on predicted cardiovascular risk:change in cardiac risk after bariatric surgery. Obesity (Silver Spring), 2007, 15(3):772-784.
13.	Kligman MD, Dexter DJ, Omer S, et al. Shrinking cardiovascular risk through bariatric surgery:application of Framingham risk score in gastric bypass. Surgery, 2008, 143(4):533-538.
14.	Torquati A, Wright K, Melvin W, et al. Effect of gastric bypass operation on Framingham and actual risk of cardiovascular events in class Ⅱ to Ⅲ obesity. J Am Coll Surg, 2007, 204(5):776-782.
15.	Vogel JA, Franklin BA, Zalesin KC, et al. Reduction in predicted coronary heart disease risk after substantial weight reduction after bariatric surgery. Am J Cardiol, 2007, 99(2):222-226.
16.	Khalaileh A, Matot I, Schweiger C, et al. Laparoscopic Roux-en-Y gastric bypass for the treatment of morbid obesity:experience with 50 patients. Isr Med Assoc J, 2008, 10(5):350-353.
17.	Maher JW, Hawver LM, Pucci A, et al. Four hundred fifty consecutive laparoscopic Roux-en-Y gastric bypasses with no mortality and declining leak rates and lengths of stay in a bariatric training program. J Am Coll Surgeons, 2008, 206(5):940-944.
18.	Sears D, Fillmore G, Bui M, et al. Evaluation of gastric bypass patients 1 year after surgery:changes in quality of life and obesity-related conditions. Obes Surg, 2008, 18(12):1522-1525.
19.	Yan E, Ko E, Luong V, et al. Long-term changes in weight loss and obesity-related comorbidities after Roux-en-Y gastric bypass:a primary care experience. Am J Surg, 2008, 195(1):94-98.
20.	Ahmed AR, Rickards G, Coniglio D, et al. Laparoscopic Roux-en-Y gastric bypass and its early effect on blood pressure. Obes Surg, 2009, 19(11):845-849.
21.	Habib P, Scrocco JD, Terek M, et al. Effects of bariatric surgery on inflammatory, functional and structural markers of coronary atherosclerosis. Am J Cardiol, 2009, 104(9):1251-1255.
22.	Prachand VN, Ward M, Alverdy JC. Duodenal switch provides superior resolution of metabolic comorbidities independent of weight loss in the super-obese (BMI>or 1/4 50 kg/m²) compared with gastric bypass. J Gastrointest Surg, 2010, 14(2):211-220.
23.	Kehagias I, Karamanakos SN, Argentou M, et al. Randomized clinical trial of laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the management of patients with BMI < 50 kg/m². Obes Surg, 2011, 21(11):1650-1656.
24.	Lee WJ, Chong K, Ser KH, et al. Gastric bypass vs. sleeve gastrectomy for type 2 diabetes mellitus:a randomized controlled trial. Arch Surg, 2011, 146(2):143-148.
25.	Mingrone G, Panunzi S, de Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med, 2012, 366(17):1577-1585.
26.	Praveen Raj P, Kumaravel R, Chandramaliteeswaran C, et al. Is laparoscopic duodenojejunal bypass with sleeve an effective alternative to Roux en Y gastric bypass in morbidly obese patients:preliminary results of a randomized trial. Obes Surg, 2012, 22(3):422-426.
27.	Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med, 2012, 366(17):1577-1585.
28.	Ikramuddin S, Korner J, Lee WJ, et al. Roux-en-Y gastric bypass vs. intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia. JAMA, 2013, 309(21):2250-2274.
29.	Nauck MA, Kemmeries G, Holst JJ, et al. Rapid tachyphylaxis of the glucagon-like peptide 1-induced deceleration of gastric emptying in humans. Diabetes, 2011, 60(5):1561-1565.
30.	Sjöström L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med, 2004, 351(26):2683-2693.
31.	Fernstrom JD, Courcoulas AP, Houck PR, et al. Long-term changes in blood pressure in extremely obese patients who have undergone bariatric surgery. Arch Surg, 2006, 141(3):276-283.
32.	宫建, 潘雯, 黄晓艳, 等.中国内地2型糖尿病患者胃转流术后1年疗效的Meta分析.中国循证医学杂志, 2012, 24(12):352-355.

1. World Health Organization. Obesity and overweight EB/OL updated 2013 Mar. Available at:http://www.cdc.gov/ncidod/EID/htm.
2. Sjöström L, Gummesson A, Sjöström CD, et al. Effects of bariatric surgery on cancer incidence in obese patients in Sweden (Swedish Obese Subjects Study):a prospective, controlled intervention trial. Lancet Oncol, 2009, 10(7):653-662.
3. Wells G, Shay B, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analysis. In:Ottawa, 2012; Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
4. Cowan GS Jr, Buffington CK. Significant changes in blood pressure, glucose, and lipids with gastric bypass surgery. World J Surg, 1998, 22(9):987-992.
5. Serra A, Granada ML, Romero R, et al. The effect of bariatric surgery on adipocytokines, renal parameters and other cardiovascular risk factors in severe and very severe obesity:1-year follow-up. Clin Nutr, 2006, 25(3):400-408.
6. White S, Brooks E, Jurikova L, et al. Long-term outcomes after gastric bypass. Obes Surg, 2005, 15(2):155-163.
7. Bowne WB, Julliard K, Castro AE, et al. Laparoscopic gastric bypass is superior to adjustable gastric band in super morbidly obese patients:a prospective, comparative analysis. Arch Surg, 2006, 141(7):683-689.
8. Cottam D, Atkinson J, Anderson A, et al. A case-controlled matched-pair cohort study of laparoscopic Roux-en-Y gastric bypass and Lap-Band patients in a single US center with three-year follow-up. Obes Surg, 2006, 16(5):534-540.
9. Puzziferri N, Austrheim-Smith IT, Wolfe BM, et al. Three-year follow-up of a prospective randomized trial comparing laparoscopic versus open gastric bypass. Ann Surg, 2006, 243(2):181-188.
10. Alexandrides TK, Skroubis G, Kalfarentzos F. Resolution of diabetes mellitus and metabolic syndrome following roux-en-y gastric bypass and a variant of biliopancreatic diversion in patients with morbid obesity. Obes Surg, 2007, 17(2):176-184.
11. Anderson WA, Greene GW, Forse RA, et al. Weight loss and health outcomes in African Americans and whites after gastric bypass surgery. Obesity (Silver Spring), 2007, 15(6):1455-1463.
12. Batsis JA, Romero-Corral A, Collazo-Clavell ML, et al. Effect of weight loss on predicted cardiovascular risk:change in cardiac risk after bariatric surgery. Obesity (Silver Spring), 2007, 15(3):772-784.
13. Kligman MD, Dexter DJ, Omer S, et al. Shrinking cardiovascular risk through bariatric surgery:application of Framingham risk score in gastric bypass. Surgery, 2008, 143(4):533-538.
14. Torquati A, Wright K, Melvin W, et al. Effect of gastric bypass operation on Framingham and actual risk of cardiovascular events in class Ⅱ to Ⅲ obesity. J Am Coll Surg, 2007, 204(5):776-782.
15. Vogel JA, Franklin BA, Zalesin KC, et al. Reduction in predicted coronary heart disease risk after substantial weight reduction after bariatric surgery. Am J Cardiol, 2007, 99(2):222-226.
16. Khalaileh A, Matot I, Schweiger C, et al. Laparoscopic Roux-en-Y gastric bypass for the treatment of morbid obesity:experience with 50 patients. Isr Med Assoc J, 2008, 10(5):350-353.
17. Maher JW, Hawver LM, Pucci A, et al. Four hundred fifty consecutive laparoscopic Roux-en-Y gastric bypasses with no mortality and declining leak rates and lengths of stay in a bariatric training program. J Am Coll Surgeons, 2008, 206(5):940-944.
18. Sears D, Fillmore G, Bui M, et al. Evaluation of gastric bypass patients 1 year after surgery:changes in quality of life and obesity-related conditions. Obes Surg, 2008, 18(12):1522-1525.
19. Yan E, Ko E, Luong V, et al. Long-term changes in weight loss and obesity-related comorbidities after Roux-en-Y gastric bypass:a primary care experience. Am J Surg, 2008, 195(1):94-98.
20. Ahmed AR, Rickards G, Coniglio D, et al. Laparoscopic Roux-en-Y gastric bypass and its early effect on blood pressure. Obes Surg, 2009, 19(11):845-849.
21. Habib P, Scrocco JD, Terek M, et al. Effects of bariatric surgery on inflammatory, functional and structural markers of coronary atherosclerosis. Am J Cardiol, 2009, 104(9):1251-1255.
22. Prachand VN, Ward M, Alverdy JC. Duodenal switch provides superior resolution of metabolic comorbidities independent of weight loss in the super-obese (BMI>or 1/4 50 kg/m²) compared with gastric bypass. J Gastrointest Surg, 2010, 14(2):211-220.
23. Kehagias I, Karamanakos SN, Argentou M, et al. Randomized clinical trial of laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the management of patients with BMI < 50 kg/m². Obes Surg, 2011, 21(11):1650-1656.
24. Lee WJ, Chong K, Ser KH, et al. Gastric bypass vs. sleeve gastrectomy for type 2 diabetes mellitus:a randomized controlled trial. Arch Surg, 2011, 146(2):143-148.
25. Mingrone G, Panunzi S, de Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med, 2012, 366(17):1577-1585.
26. Praveen Raj P, Kumaravel R, Chandramaliteeswaran C, et al. Is laparoscopic duodenojejunal bypass with sleeve an effective alternative to Roux en Y gastric bypass in morbidly obese patients:preliminary results of a randomized trial. Obes Surg, 2012, 22(3):422-426.
27. Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med, 2012, 366(17):1577-1585.
28. Ikramuddin S, Korner J, Lee WJ, et al. Roux-en-Y gastric bypass vs. intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia. JAMA, 2013, 309(21):2250-2274.
29. Nauck MA, Kemmeries G, Holst JJ, et al. Rapid tachyphylaxis of the glucagon-like peptide 1-induced deceleration of gastric emptying in humans. Diabetes, 2011, 60(5):1561-1565.
30. Sjöström L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med, 2004, 351(26):2683-2693.
31. Fernstrom JD, Courcoulas AP, Houck PR, et al. Long-term changes in blood pressure in extremely obese patients who have undergone bariatric surgery. Arch Surg, 2006, 141(3):276-283.
32. 宫建, 潘雯, 黄晓艳, 等.中国内地2型糖尿病患者胃转流术后1年疗效的Meta分析.中国循证医学杂志, 2012, 24(12):352-355.

Chinese Journal of Evidence-Based Medicine

Efficacy of Roux-en-Y Gastric Bypass for Obesity and Its Comorbidities: A Meta-Analysis

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