Treatment Options for Poor Responders to Bariatric Surgery
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OBESITY TREATMENT (CM APOVIAN, SECTION EDITOR)
Treatment Options for Poor Responders to Bariatric Surgery Phong Ching Lee 1
&
John B. Dixon 2 & Pei Yin Sim 3 & Chin Hong Lim 3
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review This review aims to evaluate the latest evidence on the treatment options for perceived poor responders to bariatric surgery and provide practitioners with a guide on when to consider revisional surgery and when to consider alternatives. Recent Findings The use of adjuvant pharmacotherapy has been increasingly described in the literature as an adjunct to primary bariatric surgery, in order to attain more weight loss or better control of obesity-related complications. The newer anti-obesity and anti-diabetes drugs also have cardiorenal benefits, which are shown in recent cardiovascular outcome trials. Revisional bariatric surgery has emerged as a distinctive entity and can be broadly organized into three categories: corrective, conversion, and reversal surgeries. Summary Careful patient selection and preoperative optimization are needed to ensure long-term favorable outcomes. Newer treatment modalities involving the use of anti-obesity medications and endoscopic bariatric interventions provide patients and healthcare providers with more options, when faced with the challenge of poor response after bariatric surgery. Keywords Bariatric surgery . Poor response . Revisional surgery . Pharmacotherapy . Weight regain . Diabetes relapse
Introduction Bariatric surgery remains the most effective treatment for clinically severe obesity, with the largest and most durable weight loss compared with other modalities. However, weight regain is very common, and it is estimated that approximately half of patients regain 5% of their weight in 2 years after bariatric surgery [1] [Busetto, 2017 #2230]. An observational study of 300 patients who had Roux-en-Y gastric bypass (RYGB) showed that 37% of the patients regained ≥ 25% of their maximal body weight loss after a mean follow-up of 7 years [2]. There is also strong data to support the association between bariatric surgery and diabetes remission in patients with type 2 This article is part of the Topical Collection on Obesity Treatment * Phong Ching Lee [email protected] 1
Department of Endocrinology, Singapore General Hospital, 20 College Rd, 169856 Singapore, Singapore
2
Clinical Obesity Research, Baker Heart and Diabetes Institute, Melbourne, Australia
3
Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, 20 College Rd, 169856 Singapore, Singapore
diabetes (T2D) and obesity. However, relapse of diabetes is common, and the Swedish Obese Subjects (SOS) study demonstrated that showed that T2D remission rates decreased from 72.3% at 2 years to 30.4% at 15 years [3•]. Similarly, a long-term prospective study of 418 patients who underwent RYGB has shown that T2D remission rates declined from 75 to 51% between years 2 and 12 after surgery [4]. The combinati
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