medwireNews: The 5-year outcomes of the Teen-LABS cohort show that adolescents who undergo bariatric surgery have a good chance of achieving diabetes remission, but may require more reoperations than adult patients.
The report in The New England Journal of Medicine compares outcomes of 161 members of the Teen-LABS cohort who underwent gastric bypass surgery between the ages of 13 and 19 years and 396 from the LABS cohort who had surgery between the ages of 25 and 50 years having been obese since their teenage years.
The average pre-surgery BMI was 50 kg/m2 in both groups and this was a markedly lower 37 and 36 kg/m2 in the adolescent and adult groups, respectively, at 5 years after surgery. Although there was no significant difference in the overall weight loss at 5 years between the two groups, significantly fewer adolescents than adults had maintained at least 20% weight loss, at 60% versus 76%.
Despite this, the proportion of people with diabetes fell from 14% to 2.4% among the adolescents and from 31% to 12% among the adults, giving significantly different remission rates at 86% versus 53%, favouring surgery in adolescence versus adulthood. Likewise, the remission rates for hypertension were 68% versus 41%, report Thomas Inge (Children’s Hospital Colorado, Aurora, USA) and co-researchers.
Both groups had marked improvements in their lipid profiles, and there were no differences between the two for remission of hypertriglyceridemia or low levels of high-density lipoprotein cholesterol.
However, the adolescents required significantly more reoperations, eg, cholecystectomy and relief of bowel obstruction, than the adults, at rates of 20% versus 16%, or 19.5 versus 10.3 per 500 person–years. They were also significantly more likely to have low ferritin levels, at 48% versus 29%.
Rates of other adverse outcomes were similar between the groups. There were three (1.9%) deaths in the adolescent group and seven (1.8%) in the adult group. Two of the deaths in the adolescent group were attributed to drug overdose; the other was a result of sepsis.
In a linked editorial, Ted Adams (University of Utah, Salt Lake City, USA) stresses the importance of these 5-year data, given that “bariatric surgery is now the only successful long-term treatment option for adolescents with severe obesity.”
Adolescents “may not have fully developed the capacity for decision making, especially about a procedure that will have lifetime consequences”, says Adams, highlighting the need for “more complete data […] to fully inform clinicians, parents, and adolescents whether to embark on surgical intervention or to postpone it.”
Adams concludes: “For now, while we hope to identify new, effective, and less-invasive therapies and effective adjuncts to bariatric surgery in adolescents (i.e. pharmacotherapy and multispecialty lifestyle integration), decisions should be made on a case-by-case basis, with the knowledge that the 5-year data look promising but that the lifetime outcome is unknown.”
By Eleanor McDermid
medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group
N Engl J Med 2019; doi:10.1056/NEJMoa1813909
N Engl J Med 2019; doi:10.1056/NEJMe1905778