Safety and Efficacy of Bariatric Surgery in Inflammatory Bowel Disease Patients: a Systematic Review and Meta-analysis
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Safety and Efficacy of Bariatric Surgery in Inflammatory Bowel Disease Patients: a Systematic Review and Meta-analysis Rajat Garg 1 & Babu P. Mohan 2 & Suresh Ponnada 3 & Amandeep Singh 4 & Ali Aminian 5 & Miguel Regueiro 4 & Benjamin Click 4 Received: 19 March 2020 / Revised: 16 May 2020 / Accepted: 19 May 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background The safety and efficacy of bariatric surgery in inflammatory bowel disease (IBD) patients is poorly understood. We conducted a systematic review and meta-analysis studying safety and efficacy of bariatric surgery in IBD patients as well as the impact of bariatric surgery on IBD course. Methods We conducted a comprehensive search of multiple databases (through September 2019) to identify studies that reported outcome of bariatric surgery in IBD patients. Outcomes assessed included the pooled rate of adverse events, change in medications after bariatric surgery, and 12-month excess weight loss (EWL) and body mass index (BMI) reduction after bariatric surgery. Results A total of 10 studies were included in final analysis. The pooled rate of early and late adverse events was 15.9% (95% CI, 9.3–25.9) and 16.9% (95% CI, 12.1–23.1), respectively. The rate of adverse events in Roux-en-Y gastric bypass was 45.6% (95% CI, 21.9–71.4) compared with 21.6% (95% CI, 11.1–38) in sleeve gastrectomy (p = 0.11). The pooled rate of 12-month EWL and BMI reduction after surgery was 66.1% (95% CI, 59.8–72.3%) and 13.7 kg/m2 (95% CI, 12.5–14.9), respectively. The pooled rate of decrease, increase, and no change of IBD medications were 45.6% (95% CI, 23.8–69.2), 11% (95% CI, 6.3–18.4), and 57.6% (95% CI, 39.2–74.1), respectively. Conclusions Bariatric surgery has acceptable safety and efficacy profile in IBD patients. Nearly half of patients had decrease in their IBD medications after bariatric surgery, and only 10% experienced therapeutic escalation following bariatric surgery. Sleeve gastrectomy may be the preferred procedure in this population. Keywords IBD . Crohn’s disease . Obesity . Bariatric surgery . Ulcerative colitis . Inflammatory bowel disease
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11695-020-04729-4) contains supplementary material, which is available to authorized users. * Rajat Garg [email protected]
Benjamin Click [email protected]
Babu P. Mohan [email protected]
1
Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
Suresh Ponnada [email protected]
2
Department of Internal Medicine, Banner University Medical Center/ University of Arizona, Tucson, AZ, USA
Amandeep Singh [email protected]
3
Department of Internal Medicine, Carilion Roanoke Medical Center, Roanoke, VA, USA
Ali Aminian [email protected]
4
Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH, USA
Miguel Regueiro [email protected]
5
Department of Laparoscopic and Bariatric Sur
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