ASMBS: No Excess Risk with Gastric Banding in Teens
Link to Article | http://www.medpagetoday.com/MeetingCoverage/ASMBS/20936
Written By: Charles Bankhead
MONDAY, June 28th 2010 (MedPage Today) — Obese adolescents lost just as much weight as adults did with no increased risk after laparoscopic adjustable gastric banding, data from a case-matched cohort study showed.
Excess weight loss increased from 21.5% at six months to 35.1% at 24 months, virtually identical to adults’ weight loss among which averaged 35.8% at 24 months.
Complications rates were similar between adults and adolescents, and both groups showed similar improvement or resolution of comorbid conditions, Jeffrey Zitsman, MD, reported here at the American Society of Metabolic and Bariatric Surgery.
The results also suggested that gastric banding has potential to prevent obesity-related comorbidities in adults and children alike.
“Adolescents have significantly fewer serious medical comorbidities than adults of comparable body mass index and gender,” said Zitsman, of Columbia University in New York. “Data from this small case-matched cohort study suggest that early intervention to reduce weight may preclude the development of more serious obesity-related comorbidities.
The findings reflected the clinical experience with adolescent bariatric surgery at Columbia since 2005, which Zitsman and others formed a multidisciplinary team to ensure the overall health and well-being of obese youngsters undergoing bariatric surgery.
The case-matched study included 115 patients ages 14 to 19, of whom 81 (70%) were female. Reflecting the ethnic mix of the neighborhood surrounding Columbia, the young patients included 47 Hispanics, 45 Caucasians, and 20 African Americans.
Adult patients for the study came from Columbia’s outpatient surgery database, and included patients who had gastric banding procedures during 2006 to 2010. Adults and adolescents were matched with respect to sex and presurgical body mass index (BMI).
Zitsman and colleagues calculated and compared percent excess weight loss and change in BMI between the groups at six, 12, and 24 months after surgery. They also compared the two groups with respect to baseline comorbid conditions.
The younger patients had a mean age of 16.4 compared with 44.8 for the adult cohort (P<0.0001). Baseline BMI averaged almost 47 in both groups. Adults had a significantly higher prevalence of diabetes (21.8% versus 2.6%, P<0.0001), hypertension (41.3% versus 19.1%, P=0.0003), and hyperlipidemia (37.6% versus 14.7%, P=0.0001). The adolescents had a higher prevalence of menstrual abnormalities (36.7% versus 13.0%, P=0.03).
Six-month excess-weight loss averaged 21.5% in the adolescents and 26.6% in the adults. Corresponding values were 32.9% and 32.5% at 12 months and 35.1% versus 35.8% at 24 months. None of the differences achieved statistical significance.
Among patients with baseline comorbid conditions, significantly more adolescents had improvement in hypertension (75% versus 34.9% for adults, P=0.03) and hyperlipidemia (87.5% versus 18.4%, P=0.0001). Significantly more adults had improvement or resolution of gastroesophageal reflux disease after bariatric surgery (55.6% versus 20%, P=0.006).
Additionally, 54.5% of adults had improvement or resolution of diabetes (versus an unknown proportion of adolescents), whereas the younger patients had 57.1% improvement in metabolic syndrome and 55.6% improvement in asthma (versus unknown in adults), and 60% improvement in abnormal menses versus 33.3% of adults (NS).
Eleven patients in each group had complications associated with bariatric surgery. The most common complications were band slippage — which occurred in three patients in each group — port malfunction in two adults and three adolescents, and esophageal dilation in four adults and one adolescent.
In response to a question from the audience, Zitsman acknowledged that the demand for bariatric services for children and adolescents currently outstrips available resources. He encouraged pediatric laparoscopic surgeons to integrate themselves into adult bariatric surgery programs to learn and benefit from the more experienced surgeons.
Conversely, he urged adult bariatric surgeons interested in treating pediatric patients to avail themselves of their pediatric surgery colleagues’ experience, particularly with respect to developmental and psychosocial issues that play a greater role in pediatric patients.
“We still believe that children are not simply miniature versions of adults,” said Zitsman. “They have many more issues, both psychologically and physiologically.”