title: Five-year outcomes after laparoscopic gastric bypass and laparoscopic duodenal switch in patients with body mass index of 50 to 60: a randomized clinical trial.
abstract: OBJECTIVE
  There is no consensus as to which bariatric procedure is preferred to reduce weight and improve health in patients with a body mass index higher than 50.
  
  
  OBJECTIVE
  To compare 5-year outcomes after Roux-en-Y gastric bypass (gastric bypass) and biliopancreatic diversion with duodenal switch (duodenal switch).
  
  
  METHODS
  Randomized clinical open-label trial at Oslo University Hospital, Oslo, Norway, and Sahlgrenska University Hospital, Gothenburg, Sweden. Participants were recruited between March 17, 2006, and August 20, 2007, and included 60 patients aged 20 to 50 years with a body mass index of 50 to 60. The current study provides the 5-year follow-up analyses by intent to treat, excluding one participant accepted for inclusion who declined being operated on prior to knowing to what group he was randomized.
  
  
  METHODS
  Laparoscopic gastric bypass and laparoscopic duodenal switch.
  
  
  METHODS
  Body mass index and secondary outcomes including anthropometric measures, cardiometabolic risk factors, pulmonary function, vitamin status, gastrointestinal symptoms, health-related quality of life, and adverse events.
  
  
  RESULTS
  Sixty patients were randomly assigned and operated on with gastric bypass (n = 31) and duodenal switch (n = 29). Fifty-five patients (92%) completed the study. Five years after surgery, the mean reductions in body mass index were 13.6 (95% CI, 11.0-16.1) and 22.1 (95% CI, 19.5-24.7) after gastric bypass and duodenal switch, respectively. The mean between-group difference was 8.5 (95% CI, 4.9-12.2; P < .001). Remission rates of type 2 diabetes mellitus and metabolic syndrome and changes in blood pressure and lung function were similar between groups. Reductions in total cholesterol, low-density lipoprotein cholesterol, triglycerides, and fasting glucose were significantly greater after duodenal switch compared with gastric bypass. Serum concentrations of vitamin A and 25-hydroxyvitamin D were significantly reduced after duodenal switch compared with gastric bypass. Duodenal switch was associated with more gastrointestinal adverse effects. Health-related quality of life was similar between groups. Patients with duodenal switch underwent more surgical procedures related to the initial procedure (13 [44.8%] vs 3 [9.7%] patients; P = .002) and had significantly more hospital admissions compared with patients with gastric bypass.
  
  
  CONCLUSIONS
  In patients with a body mass index of 50 to 60, duodenal switch resulted in greater weight loss and greater improvements in low-density lipoprotein cholesterol, triglyceride, and glucose levels 5 years after surgery compared with gastric bypass while improvements in health-related quality of life were similar. However, duodenal switch was associated with more surgical, nutritional, and gastrointestinal adverse effects.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00327912.
authors: Department of Endocrinology, Morbid Obesity, and Preventive Medicine, Oslo University Hospital, Oslo, Norway2Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors: Hilde
authors: H
authors: Risstad
authors: Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway.
authors: Torgeir T
authors: TT
authors: Søvik
authors: Department of Gastrosurgical Research and Education, Department of Surgery, Sahlgrenska University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors: My
authors: M
authors: Engström
authors: Department of Endocrinology, Morbid Obesity, and Preventive Medicine, Oslo University Hospital, Oslo, Norway.
authors: Erlend T
authors: ET
authors: Aasheim
authors: Unit of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway.
authors: Morten W
authors: MW
authors: Fagerland
authors: Department of Gastrosurgical Research and Education, Department of Surgery, Sahlgrenska University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors: Monika Fagevik
authors: MF
authors: Olsén
authors: Department of Endocrinology, Morbid Obesity, and Preventive Medicine, Oslo University Hospital, Oslo, Norway.
authors: Jon A
authors: JA
authors: Kristinsson
authors: Department of Gastrosurgical Research and Education, Department of Surgery, Sahlgrenska University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden6Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dubl.
authors: Carel W
authors: CW
authors: le Roux
authors: Nutritional Laboratory, Biochemical Department, Oslo University Hospital, Oslo, Norway.
authors: Thomas
authors: T
authors: Bøhmer
authors: Department of Endocrinology, Morbid Obesity, and Preventive Medicine, Oslo University Hospital, Oslo, Norway.
authors: Kåre I
authors: KI
authors: Birkeland
authors: Department of Endocrinology, Morbid Obesity, and Preventive Medicine, Oslo University Hospital, Oslo, Norway3Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway.
authors: Tom
authors: T
authors: Mala
authors: Department of Gastrosurgical Research and Education, Department of Surgery, Sahlgrenska University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors: Torsten
authors: T
authors: Olbers
mesh_terms: D000328:Adult; D000886:Anthropometry; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D004386:Duodenum / Q000601:surgery*; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D009664:Norway; D009767:Obesity, Morbid / Q000601:surgery*; D011788:Quality of Life; D013548:Sweden; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D001786:Blood Glucose; D008055:Lipids