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Comparative Effectiveness Review of Mini Gastric Bypass–One Anastomosis Gastric Bypass for the Treatment of Obesity: A Review of Reviews

May 30, 2019

Health Problem: Obesity is a common condition in the United States, where approximately 37.7% of adults aged 20 years and older are considered obese. Data from 2013 to 2014 show a rate of obesity of 17.2% among younger individuals aged 2 to 19 years. Morbid obesity is associated with substantively elevated morbidity and mortality due to comorbid conditions, including type 2 diabetes mellitus, hypertension, dyslipidemia, and obstructive sleep apnea. Class II (body mass index [BMI] 35 to 39.9 kilograms per square meter [kg/m2] and class III [BMI ≥ 40 kg/m2] obesity are associated with increased all-cause mortality. In the United States, an estimated 228,000 bariatric surgeries were performed in 2017. In general, patients with class II or higher obesity may be candidates for bariatric surgery.

Technology Description: Mini gastric bypass–one anastomosis gastric bypass (MGB-OAGB) entails the creation of a long-sleeved gastric pouch and an antecolic anastomosis between the pouch and the jejunum, typically 180 to 220 centimeters in length. It is both a restrictive and a malabsorptive bariatric surgery. It is both a restrictive and a malabsorptive bariatric surgery.

Controversy: Roux-en-Y gastric bypass (RYBG) and laparoscopic sleeve gastrectomy (LSG) are widely used bariatric surgeries with demonstrated success for weight loss and safety. MGB-OAGB has not been accepted as a valid alternative; accordingly, evidence review is warranted to inform decision making. In addition, concerns about risk, including bilio-enteric reflux and increased risk of esophageal and gastric cancer, have been raised.

Key Questions:

For adults with morbid obesity:

  • How do clinical outcomes of MGB-OAGB compare with RYGB in terms of weight loss and other obesity-related morbidities?
  • How do clinical outcomes of MGB-OAGB compare with LSG in terms of weight loss and other obesity-related morbidities?
  • What complications are associated with MGB-OAGB and how do they compare with RYGB and LSG?
  • Have definitive patient selection criteria for MGB-OAGB been established?