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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

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Abstract

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/m2 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/m2, 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/m2, SG appeared to provide a cost-effective choice.

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Acknowledgements

The authors thank all surgeons, registrars, administrative nurses, and technicians who registered patients in the GC-MBD. We also sincerely thank the participating investigators for this study group from the following centers: Hongwei Lin, M.D., Ph.D., Department of Gastrointestinal Surgery, Beijing Tsinghua Changgung Hospital; Jinghai Song, M.D., Ph.D., Department of General Surgery, Beijing Hospital; Ruicheng Yan, M.D., Ph.D., Department of Gastrointestinal Surgery & Department of Metabolic and Bariatric Surgery, East District of Renmin Hospital of Wuhan University; Zhen Li., M.D., Ph.D., Department of Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University; Wei Yang, M.D., Ph.D., Department of Hepatobiliary, The First Affiliated Hospital of Xi’an Jiaotong University; Bing Wang, M.D., Ph.D., Department of General Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine; Lisheng Wu, M.D., Ph.D., Department of General Surgery, Division of Life Sciences and Medicine, The First Affiliated Hospital of University of Science and Technology of China; Yanjun Liu, M.D., Ph.D., Gastrointestinal Minimally Invasive Centre • Centre for Obesity and Metabolic Diseases, Chengdu Third People’s Hospital; Shaihong Zhu., M.D., Ph.D., Department of General Surgery, The Third Xiangya Hospital of Central South University; Kelimu abudureyimu, M.D., Ph.D., Department of General Surgery, Xinjiang Uygur Autonomous Region People’s Hospital; Zhifei Li.,M.D., Ph.D., Department of General Surgery, Peking University Third Hospital; Yongtao Yu, M.D., Ph.D., Department of Gastrointestinal Surgery, General Hospital of Ningxia Medical University; Hongzhi Zhao, M.D., Ph.D., Department of Hepatobiliary and Extrapancreatic Surgery, Tianjin Hospital of ITCWM Nankai Hospital; Xiaoyu Liang, M.D., Ph.D., Department of General Surgery, Tianjin Medical University General Hospital; Mingxing Ding, M.D., Ph.D., Department of General Surgery, Jiahe Surgical Hospital Changchun; Qiang Xu, M.D., Ph.D., Department of General Surgery, Peking Union Medical College Hospital; Lei Chen, M.D., Ph.D., Department of General Surgery, Qilu Hospital of Shandong University (Qingdao); Zhijun Wang., M.D., Department of General Surgery, The People’s Hospital of Anyang City; Peichun Sun, M.D., Ph.D., Department of Gastrointestinal Surgery, Henan Provincial People’s Hospital; Jianhui Yin, M.D., Ph.D., Department of General Surgery, The First Hospital of Kunming; Ju Wang, M.D., Ph.D., Department of General Surgery, Inner Mongolia People’s Hospital; Jianlin Wu, M.D., Ph.D., Department of General Surgery, ZiBo Central Hospital; Zhifei Wang, M.D., Department of Hepatobiliary, Pancreatic and Minimally Invasive Surgery, Zhejiang Provincial People’s Hospital.

Funding

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). For the remaining authors, none was declared.

Author information

Author notes

  1. Mengyi Li and Na Zeng contributed equally to this work.

Authors and Affiliations

  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

    Mengyi Li, Yang Liu, Peng Zhang & Zhongtao Zhang

  2. National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China

    Na Zeng

  3. Department of General Surgery, Beijing Tiantan Hospital, Capital Medical University, No. 119, South West Ring Road, Fengtai District, Beijing, 100070, China

    Wenmao Yan & Rixing Bai

  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

    Songhai Zhang

  5. Jinshazhou Hospital of Guangzhou University of Chinese Medicine, No.1 Li-Chuan East Street, Baiyun District, Guangzhou, 510168, Guangdong Province, China

    Liangping Wu

  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

    Shaozhuang Liu

  7. Department of Gastrointestinal Surgery, Tangshan Gongren Hospital, No.27 Cultural Road, Lubei District, Tangshan, 063000, Hebei Province, China

    Jun Wang

  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

    Xiangwen Zhao

  9. Department of General Surgery, Bethune Hospital of Shanxi, No.99 Longcheng Street, Xiaodian District, Taiyuan, 030032, Shanxi Province, China

    Jianli Han

  10. Department of General Surgery, The Second Hospital of Hebei Medical University, No.215 Heping West Road, Shijiazhuang, 050000, Hebei Province, China

    Jiansheng Kang

  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

    Nengwei Zhang

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  1. Mengyi Li
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  2. Na Zeng
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  3. Yang Liu
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Consortia

for the Greater China Metabolic and Bariatric Surgery Database (GC-MBD) study group

  • Hongwei Lin
  • , Jinghai Song
  • , Ruicheng Yan
  • , Zhen Li
  • , Wei Yang
  • , Bing Wang
  • , Lisheng Wu
  • , Yanjun Liu
  • , Shaihong Zhu
  • , Kelimu Abudureyimu
  • , Zhifei Li
  • , Yongtao Yu
  • , Hongzhi Zhao
  • , Xiaoyu Liang
  • , Mingxing Ding
  • , Qiang Xu
  • , Lei Chen
  • , Zhijun Wang
  • , Peichun Sun
  • , Jianhui Yin
  • , Ju Wang
  • , Jianlin Wu
  •  & Zhifei Wang

Contributions

ZTZ and PZ conceived the study and are the principal investigators. YL, WMY, SHZ, LPW, SZL, JW, XWZ, JLH, JSK, and NWZ contributed to the design and oversaw the study conduct. MYL and NZ wrote the manuscript and responsible for the statistical analysis. All authors critically participated in interpretation of the data, reviewed the manuscript for intellectual content, and approved the final version of the manuscript.

Corresponding authors

Correspondence to Peng Zhang, Rixing Bai or Zhongtao Zhang.

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Conflict of Interest

The authors declare no competing interests.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in this study.

Statement of Human and Animal Rights

This study was performed in accordance with the principles of the Declaration of Helsinki and was approved by the Ethics Committees of Beijing Friendship Hospital, Capital Medical University.

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Key points

• Diabetes duration with a cutoff value of 5 years and BMI level with 35.5 kg/m2 were identified as the influential factors for surgical procedure selection in real setting.

• 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/m2, SG appeared to provide a cost-effective choice.

• There were no differences in major complications (bleeding, leakage, obstruction, stricture, and ulceration) between RYGB and SG.

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Li, M., Zeng, N., Liu, Y. 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. OBES SURG 31, 3975–3989 (2021). https://doi.org/10.1007/s11695-021-05459-x

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