Health Technology Brief

supporting sound, evidence-based decision making

Single-Anastomosis Duodenal Switch for Weight Loss

February 7, 2018

Health Problem: More than one-third of the adults in the United States are obese. Obesity is associated with elevated morbidity and mortality and with increased risk for the following conditions: hypertension, dyslipidemia, type 2 diabetes mellitus, coronary heart disease, stroke, gall bladder disease, osteoarthritis, sleep apnea and breathing problems, certain cancers, and mental illness (e.g., depression, anxiety). High levels of obesity are very unlikely to resolve without intervention and lifestyle changes alone fail to confer adequate weight loss for many patients. Bariatric surgery is generally recognized as an effective and durable treatment for higher classes of obesity in patients for whom conservative and medical interventions have been inadequate.

Technology Description: Single-anastomosis duodenal switch (SADS) is comprised of a sleeve gastrectomy to remove most of the stomach and an intestinal bypass to shorten the length of small the intestine and to allow bile and pancreatic digestive juices to mix with the food. It is a modification of the biliopancreatic diversion with duodenal switch procedure that eliminates 1 intestinal anastomosis. SADS is typically performed laparoscopically as an inpatient procedure.

Controversy: The most effective bariatric surgery to date is biliopancreatic diversion with duodenal switch (BPD-DS); however, it has fallen out of favor because it is complicated to perform and associated with significant adverse effects (Doyon, 2016). SADS is a modification of BPD-DS that is a less complicated technique and may have fewer adverse effects than BPD-DS. It is unclear whether patients treated with SADS achieve weight loss equivalent to that of current bariatric procedures.

Key Questions:

  • Is SADS effective at promoting weight loss?
  • How does SADS compare with alternative bariatric surgeries?
  • Is SADS safe for treatment of obesity?
  • Have definitive patient selection criteria been identified for use of SADS as a treatment for obesity?