Meta-analysis of Long-term De Novo Acid Reflux-Related Outcomes Following Sleeve Gastrectomy: Evidence Against the Need for Routine Postoperative Endoscopic Surveillance.

OBJECTIVES: To evaluate the incidence of long-term de novo acid reflux-related complications following sleeve gastrectomy (SG) to determine whether routine postoperative surveillance endoscopy is necessary. METHODS: A systematic search of Medline, Embase, CINAHL, CENTRAL, the Web of Science, and bibliographic reference lists was conducted. A proportion meta-analysis model was constructed to quantify the risk of the de novo gastro-oesophageal reflux disease (GORD), oesophagitis, and Barrett's oesophagus (BE) at least 4 years after SG. Random-effects modelling was applied to calculate pooled outcome data. RESULTS: Thirty-two observational studies were included reporting a total of 7904 patients who underwent primary SG and were followed up for at least 4 years. The median follow-up period was 60 months (48-132). Preoperative acid-reflux symptoms existed in 19.1% ± 15.1% of the patients. The risk of development of de novo GORD, oesophagitis, and BE after SG was 24.8% (95% CI 18.6-31.0%), 27.9% (95% CI 17.7-38.1%), and 6.7% (95% CI 3.7-9.7%), respectively. The between-study heterogeneity was significant in all outcome syntheses. It was suspected that several of the included studies have not reported BE and oesophagitis because such events might not have happened in their cohorts. CONCLUSIONS: Long-term risk of de novo GORD after SG seems to be comparable with those of the general population which questions the merit of surveillance endoscopy after SG in asymptomatic patients. De novo BE and oesophagitis after SG have not been reported by most of the available studies which may lead to overestimation of the rates of both outcomes in any evidence synthesis. We recommend endoscopic surveillance for symptomatic patients only.

Systematic review and retrospective validation of prediction models for weight loss after bariatric surgery.

BACKGROUND: Patients often have less than realistic expectations of the weight loss they are likely to achieve after bariatric surgery. It would be useful to have a well-validated prediction tool that could give patients a realistic estimate of their expected weight loss. OBJECTIVES: To perform a systematic review of the literature to identify existing prediction models and attempt to validate these models. SETTING: University hospital, United Kingdom. METHODS: A systematic review was performed. All English language studies were included if they used data to create a prediction model for postoperative weight loss after bariatric surgery. These models were then tested on patients undergoing bariatric surgery between January 1, 2013 and December 31, 2014 within our unit. RESULTS: An initial literature search produced 446 results, of which only 4 were included in the final review. Our study population included 317 patients. Mean preoperative body mass index was 46.1 ± 7.1. For 257 (81.1%) patients, 12-month follow-up was available, and mean body mass index and percentage excess weight loss at 12 months was 33.0 ± 6.7 and 66.1% ± 23.7%, respectively. All 4 of the prediction models significantly overestimated the amount of weight loss achieved by patients. The best performing prediction model in our series produced a correlation coefficient (R2) of .61 and an area under the curve of .71 on receiver operating curve analysis. CONCLUSIONS: All prediction models overestimated weight loss after bariatric surgery in our cohort. There is a need to develop better procedures and patient-specific models for better patient counselling.

Systematic Review and Meta-Analysis of Occupational Outcomes after Bariatric Surgery.

INTRODUCTION: Obesity has been linked with reduced productivity in the workplace and is associated with higher levels of unemployment and absenteeism. Studies have shown improvement in functioning and enhanced activity levels in patients after bariatric surgery. OBJECTIVES: We perform a systematic review and meta-analysis of the literature to assess the impact of bariatric surgery on occupational outcomes. METHODS: Medline, Embase, The Cochrane Library and NHS Evidence were searched for English language studies assessing factors related to employment both preoperatively and postoperatively. RESULTS: The initial search produced 189 results. Ten studies met our inclusion criteria and were included in the review. Meta-analysis did not suggest a significant improvement in overall employment rates after surgery (RR 1.058, p = 0.155). However, pooled analysis of studies analysing unemployed patients separately demonstrates that 26.4 % (95 % CI 21.6-31.5 %) of unemployed patients are able to return to work after bariatric surgery. Pooled analysis on two studies suggests that those undergoing surgery are 3.24 (p = 0.01) times more likely to return to work than non-surgical controls. Three studies demonstrated significant reductions in the mean number of annual sick days. CONCLUSIONS: There is limited evidence in the literature regarding occupational outcomes following bariatric surgery, and further studies are required before firm conclusions can be drawn. However, the existing evidence does suggest that bariatric surgery has a generally positive impact on occupational outcomes. This suggests that surgery may have wider economic, social and psychological benefits above and beyond its immediate health benefits.