Gastric Bypass Bests Banding for Controlling Diabetes and Hypertension, Lowering Cholesterol

Gastric Bypass Bests Banding for Controlling Diabetes and Hypertension, Lowering Cholesterol


September 25, 2014




DALLAS, Tex -- September 25, 2014 -- Gastric bypass surgery has better outcomes than gastric banding for long-term weight loss, controlling type 2 diabetes and high blood pressure, and lowering cholesterol levels, according to a study published in JAMA.

The review found that those undergoing gastric bypass operations lost more weight -- an average of 66% of their excess weight compared with 45% average excess weight loss for those undergoing gastric banding procedures.

“We know gastric bypass brings more weight loss success and relief of commonly associated illness versus gastric band at one year after surgery,” said Nancy, Puzziferri, MD, University of Texas Southwestern, Dallas, Texas. “We now have the best evidence available telling us this outcome continues to be true even up to 5 years after surgery. We also know these procedures maintain their safety profile long-term.”

The researchers found dramatic differences between the 2 procedures in controlling diabetes. More than two-thirds of patients with diabetes who underwent gastric bypass surgery saw remission of the disease, compared with less than a third of those who underwent gastric band procedures.

Gastric bypass surgery also lowered hypertension better than gastric banding. Nearly half of patients (48%) with hypertension reported remission after 2 years with gastric bypass, compared with less than a fifth (17%) for those undergoing gastric band procedures.

Gastric bypass also improved hyperlipidaemia, characterised by high levels of cholesterol, triglycerides, and lipoproteins in the blood. About 60% of patients in the gastric bypass group reported remission in the studies, compared with about 23% of patients in the gastric band group.

“The review underscores the importance of thinking about durable treatments, as obesity, type 2 diabetes, hypertension, and elevated cholesterol are chronic illnesses, rather than focusing on short-term results,” said Dr. Puzziferri.

Long-term complication rates for the 2 procedures also favoured gastric bypass, through both were relatively low (<3% for bypass surgery and <5% for banding procedures).

The review focused only on studies that followed patients for at least 2 years and in which more than 80% of patients were successfully tracked during that time; 29 studies total. Most -- 97% -- of weight-loss surgery studies track only a small percent of patients and/or only for up to 1 year.

The researchers suggested more studies are needed to look at long-term outcomes -- at least 2 years past the initial surgery -- while maintaining follow-up of at least 80% to be considered reliable. They also concluded there were not a sufficient number of studies meeting these criteria to accurately assess gastric sleeve procedures.

“It is also very important to understand sleeve gastrectomy, which with the evidence we have so far, appears to perform as well as gastric bypass for weight loss,” said Dr. Puzziferri. “We just don’t have as much evidence, in quantity or quality, as we have for the other procedures. The evidence will come in time. We have not been doing sleeve gastrectomies for as many years as we have been performing gastric bypass or gastric band surgeries.”