BPD/DS

[Guest guest]

Just read this on Medscape this morning, posted there last March,,,,,for

whatever it is worth ........

Dan Slone

Surgery 5/2/2000

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Biliopancreatic Diversion With a Duodenal Switch

Question

Is biliopancreatic diversion with duodenal switch an approved procedure for

the treatment of morbid obesity? If so, what are the indications, success

rate, and morbidity rate? Response

from http://www.medscape.com/Medscape/features/ResourceCenter/obesity/AskExpert\

s/public/ExpertsPanel.html#Pories " >Walter J. Pories, MD, 03/08/01

The biliopancreatic diversion with duodenal switch is a relatively new

procedure that has yet to be shown as safe and effective in long-term

studies.[1] Proponents state that the operation is technically easier than

gastric bypass and is associated with an equal risk of complications (1% to

10%) and mortality.[2-4] Advocates also report weight loss rates ranging from

65% to 80% of excess initial weight and deny that malnutrition is a

clinically significant problem.[2] However, anemia, hypocalcemia, and

hypoalbuminemia have been reported in patients undergoing this procedure.[3]

Furthermore, diarrhea and halitosis are common side effects.My major concern

is that the experience with this procedure is limited to the short term. I

have not been able to find a long-term study with an acceptable follow-up

rate. Accordingly, my bias is that the enthusiasm for the procedure is

premature and may not be well founded at this time.The indications for this

operation are the same as for a gastric bypass. Patients with a body mass

index (BMI) > 40 who do not have associated comorbidities and patients with a

BMI > 35 who have significant illnesses associated with the obesity are good

candidates for this procedure. In short, we are more likely to operate on

patients with a lower BMI if they have comorbidities such as sleep apnea,

diabetes, hypertension, and pseudo-tumor cerebri. Contraindications for this

surgery include uncontrolled depression or other psychologic disease,

substance abuse, alcoholism, failure to agree to a long-term follow-up,

inadequate intelligence to understand the operation, and patients with

unrealistic expectations. Based on our experience and reports in the

literature on other surgical procedures for the treatment of morbid obesity,

I am also concerned about the long-term effects of this " malabsorptive

operation, " especially in regard to deficiencies of B12, B6, iron, and folic

acid.Please do not interpret my remarks as a condemnation of the procedure.

It may turn out to be a fine alternative to gastric bypass. At the present

time, however, I and many other bariatric surgeons consider the procedure

experimental, interesting, and perhaps even promising. Accordingly, I believe

that until we have better data on its efficacy and safety, the

biliopancreatic diversion with duodenal switch procedure should be performed

only at institutions that are conducting rigorous clinical trials.