title: Deep brain stimulation compared with bariatric surgery for the treatment of morbid obesity: a decision analysis study.
abstract: OBJECTIVE
  Roux-en-Y gastric bypass is the gold standard treatment for morbid obesity, although failure rates may be high, particularly in patients with a BMI > 50 kg/m(2). With improved understanding of the neuropsychiatric basis of obesity, deep brain stimulation (DBS) offers a less invasive and reversible alternative to available surgical treatments. In this decision analysis, the authors determined the success rate at which DBS would be equivalent to the two most common bariatric surgeries.
  
  
  METHODS
  Medline searches were performed for studies of laparoscopic adjustable gastric banding (LAGB), laparoscopic Roux-en-Y gastric bypass (LRYGB), and DBS for movement disorders. Bariatric surgery was considered successful if postoperative excess weight loss exceeded 45% at 1-year follow-up. Using complication and success rates from the literature, the authors constructed a decision analysis model for treatment by LAGB, LRYGB, DBS, or no surgical treatment. A sensitivity analysis in which major parameters were systematically varied within their 95% CIs was used.
  
  
  RESULTS
  Fifteen studies involving 3489 and 3306 cases of LAGB and LRYGB, respectively, and 45 studies involving 2937 cases treated with DBS were included. The operative successes were 0.30 (95% CI 0.247-0.358) for LAGB and 0.968 (95% CI 0.967-0.969) for LRYGB. Sensitivity analysis revealed utility of surgical complications in LRYGB, probability of surgical complications in DBS, and success rate of DBS as having the greatest influence on outcomes. At no values did LAGB result in superior outcomes compared with other treatments.
  
  
  CONCLUSIONS
  Deep brain stimulation must achieve a success rate of 83% to be equivalent to bariatric surgery. This high-threshold success rate is probably due to the reported success rate of LRYGB, despite its higher complication rate (33.4%) compared with DBS (19.4%). The results support further research into the role of DBS for the treatment of obesity.
authors.affiliation: Department of Neurosurgery, Center for Weight and Eating Disorders, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA.
authors.forename: Jared M
authors.initials: JM
authors.lastname: Pisapia
authors.forename: Casey H
authors.initials: CH
authors.lastname: Halpern
authors.forename: Noel N
authors.initials: NN
authors.lastname: Williams
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Wadden
authors.forename: Gordon H
authors.initials: GH
authors.lastname: Baltuch
authors.forename: Sherman C
authors.initials: SC
authors.lastname: Stein
mesh_terms: D050110:Bariatric Surgery / Q000379:methods* / Q000706:statistics & numerical data; D003661:Decision Support Techniques; D046690:Deep Brain Stimulation / Q000379:methods* / Q000706:statistics & numerical data; D015390:Gastric Bypass / Q000379:methods; D015391:Gastroplasty / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D009767:Obesity, Morbid / Q000601:surgery* / Q000628:therapy*; D016896:Treatment Outcome