Presented by: Ghanshyam Goyal, MD

Authors: 

Ghanshyam Goyal, MD – ILS Hospitals
Om Tantia, Head – ILS Hospitals
Tamonas Chaudhuri, MD – ILS Hospitals
Shashi Khanna, MD – ILS Hospitals
Anshuman Poddar, MD – ILS Hospitals
Sabyasachi Goswani, MD – ILS Hospitals

Objective:

The objective of this study is to compare 5-year follow-up results of One Anastomosis Gastric Bypass / Mini Gastric Bypass (MGB-OAGB) and Laparoscopic Sleeve Gastrectomy (LSG) for the glycemic control and the weight loss achieved.

Methods:

We compared the change in HbA1c and the body weight across the prospective randomized study in 78 T2DM patients, BMI >35kg/m2 and < 60 kg/m2, who underwent LSG (n=37) and MGB-OAGB (n=41) during 2012 to 2015 and followed for five year. Student t-test and ANOVA were used for statistical analysis

Results:

The follow-up rate at 5 year after surgery was 72%. The diabetes remission at first, second, third, fourth and fifth year was 83.6 %, 87.7%, 89.1%, 88.1%, 85% in the MGB-OAGB patients and 76.58 %, 85.2%, 81.8%, 70.7%, 56.7%, in the LSG patients, respectively, with significant difference at fourth (p=0.05) and fifth year (p=0.006). The mean HbA1c decrease from baseline to fifth year follow up in MGB-OAGB -3.4 % (SD ±1.3, 95% CI – 3.8 to -3) was significantly higher than in LSG patients was -3.42.6 % (SD ±1.4, 95%CI – 3 to -2.1) (p=0.0086). The mean HbA1c at first, second, third, fourth and fifth year in the MGB-OAGB patients (6.4±0.28, 6.2±0.23, 6.1±0.26, 6.2±0.49, 6.3±0.62) (p=0.0395) and LSG patients was (6.4±0.39, 6.4±0.32, 6.3±0.3, 6.5±0.75, 6.7±1) (p=0.035). The percentage of the excess weight loss at first, second, third, fourth and fifth year was 66.19 %, 64.77 %, 66.48%, 66.6%, 65% in the MGB-OAGB patients and 63.97 %, 62.79%, 61.15%, 58.17%, 55.94%, in the LSG patients, respectively, with significant difference at fourth (p=0.0128) and fifth year (p=0.0099)

Discussion/Conclusion:

In our study, we observed that the durability of the reversal of the diabetes, HbA1c reductions and the percentage of excess weight loss, which was statistically significant, in both the patient groups, MGB-OAGB and LSG. The difference between the groups was statistically significant from fourth year follow up onwards with greater metabolic benefits observed in the MGB-OAGB group. The better performance of MGB-OAGB for T2DM remission and sustained glycemic control compared to LSG is possibly due to its restriction, better incretin effect and fat malabsorption. The strength of our study is the comparative distinction for the long term glycemic control for the two different bariatric procedures

Presented by: Lindsay Carafone, MD

Authors:

Lindsay Carafone, M.D. – Mayo Clinic Rochester
Irina Bancos, M.D. – Mayo Clinic Rochester

Objective:

Mild autonomous cortisol secretion (MACS), also known as subclinical Cushing's syndrome, affects at least 30% of patients with adrenal adenomas and is defined by abnormal cortisol after 1 mg overnight dexamethasone suppression (DST). Measurement of dehydroepiandrosterone-sulfate (DHEAS) and corticotropin (ACTH) were reported to improve diagnostic accuracy of MACS in several small studies. The objective of this study was to determine the diagnostic accuracy of DHEAS and ACTH in MACS.

Methods:

Retrospective study of patients with adrenal adenoma with both DST and DHEAS measurements (n=389). Subgroup analysis was performed in patients with ACTH measurements (n=175, 45%) and patients with adrenalectomy (n=147, 38%). MACS was defined as DST >1.8 mcg/dL. DHEAS was analyzed as DHEAS ratio (DHEAS/DHEAS lower sex- and age-range).

Results:

Of 389 patients, 271 (70%) were women, with a median age at diagnosis of 59 (20-89) years. Patients presented with unilateral (left (190, 24%), right (107, 28%)) or bilateral (92, 24%) adenomas with a median size of 25 (5-185) mm. MACS was diagnosed in 195 (50%) patients and median DST was 3.3 (1.9-25) mcg/dL. Patients with MACS demonstrated lower DHEAS ratio (median 1.7 (0.02-15) vs 2.9 (0.03-17), p< 0.0001) and lower ACTH (median 8.8 (1.1-59) pg/mL vs 15 (4-74) pg/mL, p=0.0008). Prevalence of MACS in patients with DHEAS ratio < 1, 1-2, and >2 was 73%, 62% and 39%, p< 0.0001. In a multivariate model of ACTH and DHEAS, DHEAS ratio < 1 and ACTH< 10 pg/mL demonstrated odds ratio of 10.4 (CI 95% 3-36) and 2.6 (CI 95% 1.6-4.4), respectively, in diagnosing MACS. Adrenalectomy was performed in 147 (38%) patients, 105 (71%) in MACS. Of 128 patients with available data, 70 (55%) were treated for adrenal insufficiency after adrenalectomy. In patients with DHEAS ratio < 1, 1-2 and >2, proportion of adrenal insufficiency was 86%, 61% and 37% (p=0.0002).

Discussion/Conclusion:

We found that DHEAS and ACTH provide additional value in diagnosing MACS. Future studies are needed to evaluate diagnostic accuracy of DHEAS prospectively.