Outcomes of Bariatric Surgery in Patients With Inflammatory Bowel Disease
*Keyvan Heshmati, *David A Harris, Ali Tavakkoli, Eric G Sheu
Brigham and women's hospital, Boston, MA
Objective: Obesity is increasing among patients with inflammatory bowel disease (IBD). We aimed to compare the safety and efficacy of Sleeve Gastrectomy (SG) and Roux-en-Y Gastric Bypass (RYGB) in this patient population. Design: Retrospective cohort study. Setting: Academic tertiary center. Patients: 56 patients with Crohn’s Disease (CD) or Ulcerative Colitis (UC) diagnosed before bariatric surgery (2002-2017) who underwent RYGB (8 CD, 10 UC) or SG (25 CD, 13 UC). Main Outcome Measures: Data on demographics, IBD medication requirement (IBD-Rx) at baseline and last follow-up recorded, preoperative comorbidities, surgical complications, and weight loss. Results: In RYGB and SG, patients presented at a similar age (45±9.3 vs. 47.2±12.2; p=0.5), pre-operative BMI (48.4±6.5 vs. 45.8±8.5; p=0.2), and mean IBD duration (8.6±6 vs. 10.8±7.5yrs p=0.3). Follow-up duration was greater in the RYGB group (99.4±45 vs. 32±22.2 months; p<0.01). CD patients had increasing IBD-Rx post RYGB than SG (37.5 vs. 4%, p=0.01). The proportion of RYGB and SG patients with stable IBD-Rx (25% vs. 56%; p=0.5) or improved IBD-Rx (37.5% vs. 40%; p=0.7) were not different. IBD-Rx were similar in UC following both RYGB and SG (60% vs. 77% stable; 40% vs. 23% improved Rx; p=0.4). There were no increases in UC-RX across groups. Mean excess BMI loss at 1 year was similar between RYGB and SG (65.9% vs. 53.9%; p=0.3) with similar accompanying improvements in comorbidities. RYGB was associated with a greater rate of 1-year complications compared to SG (28% vs. 4%; p=0.02). Conclusions: In CD, SG was superior to RYGB in terms of IBD-Rx post-bariatric surgery. No differences were seen in IBD-Rx in UC. SG offered similar weight loss outcomes to RYGB with a lower overall complication rate.
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