The long-term outcomes after a Biliopancreatic Diversion.

A Biliopancreatic Diversion without (BPD) or with Duodenal Switch (BPD/DS) is performed relatively infrequently. The risks and benefits are still debated, since only minimal data on the long-term efficacy and safety of BPD/DS are available. To investigate the long-term effects, a retrospective cohort study was conducted among 100 BPD or BPD/DS patients.

Long-term follow-up

Among other factors like weight loss and comorbidity, the researchers assessed improvements in nutritional status and deficiency risk. All patients were instructed to take several food supplements, and their blood levels were regularly evaluated. The importance of supplementation was emphasized, but nutritional compliance was not routinely measured.

High risk of nutritional deficiencies

This study shows a high prevalence of several micronutrient deficiencies after a BPD or BPD/DS. Substantial deficiencies were found in fat soluble vitamins D (89%) and K (65), as well as in minerals like zinc (65%). Anemia was also commonly found (57%), with a higher incidence among BPD patients versus BPD/DS patients. Protein malnutrition (3-11%) may be the most serious deficiency, possibly leading to comorbidities.

Excess weight loss and quality of life

Excess weight loss was sustained after 10-15 years, supporting long-term efficacy of BPD and BPD/DS. Comorbidities significantly improved: less hypertension, less diabetes and less hyperlipidemia were found in the long-term. However, 37% of patients developed long-term complications requiring surgery for a variety of reasons like incisional hernia and bowel obstruction. Nevertheless, 94% of the patients were highly satisfied with their choice of surgery, despite nutritional deficiencies and postoperative complications.

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Reference:

Sethi, M., Chau E., Youn A., Jiang Y., Fielding G., Ren-Fielding C. (2016) Long-term outcomes after biliopancreatic diversion with and without duodenal switch: 2-, 5-, and 10-year data. Surgery for Obesity and Related Diseases 12 (2016) 1697–1705

Link to full text: https://www.soard.org/article/S1550-7289(16)00096-4/fulltext