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Weighing Risks and Benefits: Comparing Outcomes of Semaglutide to RYGB Conversion Following Sleeve Gastrectomy
Katherine Wasden
1, Vasundhara Mathur
2, Thomas Shin
2, Abdelrahman Nimeri
2, Ali Tavakkoli
2, Eric Sheu
2
1Harvard Medical School, Boston, MA, 2Brigham and Women's Hospital, Boston, MA
Background: Following sleeve gastrectomy (SG), many patients experience recurrent weight regain (RWR) and suboptimal weight loss (SWL). Roux-en-Y gastric bypass (RYGB) conversion is standard treatment for these complications, but Semaglutide has shown benefit. This retrospective cohort study aims to directly compare outcomes of RYGB versus Semaglutide for treatment of RWR and SWL after SG.
Methods: Patients at a tertiary care hospital with RYGB conversion (n=167) were matched 1:1 to patients taking Semaglutide after SG (n=167) based on: age, gender, race, ethnicity, BMI, diabetes, and time between SG and intervention. Weight outcomes and complications were collected.
Results: Cohorts were majority white, non-Hispanic, female, and non-diabetic with pre-intervention BMIs averaging 37.8 kg/m2. Including SG weight loss, percent total body weight loss (%TBWL) was greater in RYGB than Semaglutide patients at 3 (22.7%, 17.2%, p=0.03) and 6 months (25.9%, 14.1%, p=0.04). At 24 months, there was no difference (26.9%, 19.3%, p=0.17) (Figure 1). Analyzing patient “responders” to Semaglutide (46%, defined as >5% TBWL after 1 year on Semaglutide), at 24 months there was no difference in %TBWL (RYGB: 26.9%, Semaglutide: 31.0%, p=0.2). 32% of RYGB patients had serious complications and 7% of Semaglutide patients stopped treatment due to side effects.
Conclusion: RYGB consistently showed greater %TBWL, although the difference compared to Semaglutide was only significant until 6 months; however, the burden of complications was high for RYGB patients.
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