Network Meta-Analysis of Metabolic Surgery Procedures for the Treatment of Obesity and Diabetes.
BACKGROUND
Metabolic surgery is part of a well-established treatment intensification strategy for obesity and its related comorbidities including type 2 diabetes (T2DM). Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG) and one-anastomosis gastric bypass (OAGB) are the most commonly performed metabolic surgeries worldwide, but comparative efficacy is uncertain. This study employed network meta-analysis to compare weight loss, T2DM remission and perioperative complications in adults between RYGB, SG and OAGB.


METHODS
MEDLINE, EMBASE, trial registries were searched for randomised trials comparing RYGB, SG and OAGB. Study outcomes were excess weight loss (at 1, 2 and 3-5 years), trial-defined T2DM remission at any time point and perioperative complications.


RESULTS
Twenty randomised controlled trials were included involving 1803 patients investigating the three metabolic surgical interventions. RYGB was the index for comparison. The excess weight loss (EWL) demonstrated minor differences at 1 and 2 years, but no differences between interventions at 3-5 years. T2DM remission was more likely to occur with either RYGB or OAGB when compared to SG. Perioperative complications were higher with RYGB when compared to either SG or OAGB. Two-way analysis of EWL and T2DM remission against the risk of perioperative complications demonstrated OAGB was the most positive on this assessment at all time points.


CONCLUSION
OAGB offers comparable metabolic control through weight loss and T2DM remission to RYGB and SG whilst minimising perioperative complications. Registration number: CRD42020199779 (https:// www.crd.york.ac.uk/PROSPERO ).
['Currie|Andrew C|AC|', 'Askari|Alan|A|', 'Fangueiro|Ana|A|', 'Mahawar|Kamal|K|']
D000328:Adult D050110:Bariatric Surgery D003924:Diabetes Mellitus, Type 2 D005743:Gastrectomy D015390:Gastric Bypass D006801:Humans D000071076:Network Meta-Analysis D009765:Obesity D009767:Obesity, Morbid D012189:Retrospective Studies D016896:Treatment Outcome
Network meta-analysis Metabolic surgery Obesity Type 2 diabetes