The Choice of Gastric Bypass or Sleeve Gastrectomy for Patients Stratified by Diabetes Duration and Body Mass Index (BMI) level: Results from a National Registry and Meta-analysis
机构：[1]Department of General Surgery, Beijing Friendship Hospital, Capital Medical University & National Clinical Research Center for Digestive Diseases, No.95 Yong-an Road, Xi-Cheng District, Beijing 100050, China首都医科大学附属北京友谊医院[2]National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China首都医科大学附属北京友谊医院[3]Department of General Surgery, Beijing Tiantan Hospital, Capital Medical University, No. 119, South West Ring Road, Fengtai District, Beijing 100070, China首都医科大学附属天坛医院[4]Department of Metabolic and Bariatric Surgery, Xinxiang Second People’s Hospital, No.389 Middle Section of Hongli Avenue, Muye District, Xinxiang 453002, Henan Province, China[5]Jinshazhou Hospital of Guangzhou University of Chinese Medicine, No.1 Li-Chuan East Street, Baiyun District, Guangzhou 510168, Guangdong Province, China[6]Department of Metabolic and Bariatric Surgery, Department of General Surgery, Qilu Hospital of Shandong University, No.107 Cultural West Road, Jinan 250012, Shandong Province, China[7]Department of Gastrointestinal Surgery, Tangshan Gongren Hospital, No.27 Cultural Road, Lubei District, Tangshan 063000, Hebei Province, China[8]Department of Metabolic and Bariatric Surgery, Xiaolan People’s Hospital of Zhongshan, No.65 Middle Section of Jucheng Avenue, Zhongshan 528415, Guangdong Province, China[9]Department of General Surgery, Bethune Hospital of Shanxi, No.99 Longcheng Street, Xiaodian District, Taiyuan 030032, Shanxi Province, China[10]Department of General Surgery, The Second Hospital of Hebei Medical University, No.215 Heping West Road, Shijiazhuang 050000, Hebei Province, China[11]Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University/Peking University, Ninth Clinical Medical College, Tieyilu 10, Yangfangdian, Haidian District, Beijing 100038, China
Purpose To determine whether sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) should be the optimal choice in patients stratified by diabetes duration and body mass index (BMI) level. Methods Classification tree analysis was performed to identify the influential factors for surgical procedure selection in real setting. Meta-analyses stratified by influential factors were conducted to compare the complete diabetes remission rates between SG and RYGB. The cost-effectiveness analysis was performed when results from meta-analysis remain uncertain. Results Among 3198 bariatric procedures in China, 824 (73%) SGs and 191 (17%) RYGBs were performed in patients with T2DM. Diabetes duration with a cutoff value of 5 years and BMI level with 35.5 kg/m(2) were identified as the influential factors. For patients with diabetes duration > 5 years, RYGB showed a significant higher complete diabetes remission rate than SG at 1 year: 0.52 (95% confidence interval (CI): 0.46-0.58) versus 0.36 (95% CI: 0.30-0.42). For patients with diabetes duration <= 5 years and BMI >= 35.5 kg/m(2), there was no significant difference between 2 procedures: 0.57 (95% CI: 0.43-0.71) for SG versus 0.66 (95% CI: 0.62-0.70) for RYGB. The cost-effectiveness ratios of SG and RYGB were 244.58 and 276.97 dollars per QALY, respectively. Conclusions For patients with diabetes duration > 5 years, RYGB was the optimal choice with regard to achieving complete diabetes remission at 1 year after surgery. However, for patients with diabetes duration <= 5 years and BMI >= 35.5 kg/m(2), SG appeared to provide a cost-effective choice.
基金：
Zhongtao Zhang has received funding from National Key
Technologies R&D Program (Grant No. 2015BAI13B09),
National Key Technologies R&D Program of China (No.
2017YFC0110904), Capital’s Funds for Health Improvement and
Research (No. 2020-1-2021). Mengyi Li has received funding
from Beijing Excellent Talents Training Funding Program (Grant
No. 2018000021469G195).
第一作者机构：[1]Department of General Surgery, Beijing Friendship Hospital, Capital Medical University & National Clinical Research Center for Digestive Diseases, No.95 Yong-an Road, Xi-Cheng District, Beijing 100050, China
共同第一作者：
通讯作者：
推荐引用方式(GB/T 7714)：
Mengyi Li,Na Zeng,Yang Liu,et al.The Choice of Gastric Bypass or Sleeve Gastrectomy for Patients Stratified by Diabetes Duration and Body Mass Index (BMI) level: Results from a National Registry and Meta-analysis[J].OBESITY SURGERY.2021,31(9):3975-3989.doi:10.1007/s11695-021-05459-x.
APA：
Mengyi Li,Na Zeng,Yang Liu,Wenmao Yan,Songhai Zhang...&Greater China Metabolic and Bariatric Surgery Database GC-MBD study group.(2021).The Choice of Gastric Bypass or Sleeve Gastrectomy for Patients Stratified by Diabetes Duration and Body Mass Index (BMI) level: Results from a National Registry and Meta-analysis.OBESITY SURGERY,31,(9)
MLA：
Mengyi Li,et al."The Choice of Gastric Bypass or Sleeve Gastrectomy for Patients Stratified by Diabetes Duration and Body Mass Index (BMI) level: Results from a National Registry and Meta-analysis".OBESITY SURGERY 31..9(2021):3975-3989
