Duodenal Switch May Excel at Type 2 Diabetes Resolution
FROM THE ANNUAL MEETING OF THE CENTRAL SURGICAL ASSOCIATION
"It seems to be a finding that exists only within our institution and that should be taken into account when we discuss with our own patients which operations they should undergo," Dr. Dorman said. "I think that duodenal switch in a patient with diabetes and BMI over 45-50 [kg/m2] is certainly a valid operation at an experienced center, as long as we understand the symptoms they may experience afterward."
Duodenal switch should remain a valid alternative because RYGB has its own inherent downfalls – notably, high marginal ulcer and stricture rates, as indicated in the current study by the trend toward significantly greater use of endoscopic procedures in the RYGB patients, said Dr. Sayeed Ikramuddin. Also, the group has now twice shown in matched patient populations the superiority by which the duodenal switch provides resolution of type 2 diabetes when compared with RYGB, added Dr. Ikramuddin, senior author and director of gastrointestinal surgery at the University of Minnesota.
"Lastly, the Roux-en-Y gastric bypass has a high long-term failure rate resulting in patients regaining their weight," Dr. Ikramuddin said in an interview. "This is a phenomenon not as common among duodenal switch patients, likely due to the more malabsorptive nature of the operation."
When asked what contraindications exist for duodenal switch surgery, Dr. Dorman replied that the only absolute contraindications are women of reproductive age because of concerns of nutritional malabsorption and patients unwilling to commit to follow-up. A patient with significant gastroesophageal reflux disease would most likely be offered RYGB, he said, noting that DS surgery had been performed on 5%-10% of their last 100 GI patients.
Dr. Dorman reported no relevant conflicts of interest.
