Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy for treating morbid obesity

4.1 In a case series of 100 patients with morbid obesity or metabolic disease treated with single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI‑S), the mean excess weight loss (EWL calculated from an ideal body mass index [BMI] of 25 kg/m2) was 95% at 12 months. This was maintained for maximum of 48 months of follow-up, with no significant differences between those who had SADI‑S 200 cm from the ileocecal valve and those with SADI‑S 250 cm. In a case series of 97 patients with obesity and type 2 diabetes treated with SADI‑S, EWL was 92% (74/80) at 2‑year follow-up and 98% (425/32) at 5‑year follow-up. Six percent (6/97) of patients failed to reach 50% EWL. In a case series of 123 patients with morbid obesity treated with stomach intestinal pylorus sparing (SIPS) procedure, EWL was 72% (64/102) at 1‑year follow-up.

4.2 In the case series of 97 patients, overall weight loss was 39% at 2‑year follow-up and 38% at 5‑year follow-up. In the case series of 123 patients, overall weight loss was 39% and patients had an average change in BMI of 19 kg/m2 at 1‑year follow-up.

4.3 In the case series of 100 patients, the mean glycaemia level decreased from 178.2 mg/dl at baseline to 94.2 mg/dl at 1‑year follow-up and to 79.6 mg/dl at 4‑year follow-up. The mean glycated haemoglobin (HbA1c) level decreased from 7.9% at baseline to 5.3% at 1‑year follow-up and to 5.0% at 4‑year follow-up. In the case series of 97 patients, the mean glycaemia level reduced from 167.6 mg/dl at baseline to 93.0 mg/dl at 1‑year follow-up and to 101.6 mg/dl at 5‑year follow-up. The mean HbA1c level reduced from 7.6% at baseline to 5.1% at 1‑year follow-up and to 5.5% at 5‑year follow-up.

4.4 In the case series of 97 patients, the overall diabetes remission rate (defined as HbA1c below 6% without antidiabetic medication for more than 1‑year) was 77% at 2 years and 52% at 5 years. Remission rates were higher for those having oral therapy (n=14) than for those having insulin therapy (n=40) (97% versus 54% at 2 years; 75% versus 38% at 5 years).

4.5 In the case series of 97 patients, type 2 diabetes recurred in 8% (4/97) of patients within 5 years (308 patient-years follow-up).

4.6 In the case series of 123 patients, mean values for the nutritional data (Vitamin A, B1, B12, D and albumin) were at normal levels at 1‑year follow-up.

4.7 The specialist advisers listed key efficacy outcomes as weight loss, remission of type 2 diabetes, resolution of obesity-related comorbidities and improvement in quality of life.