Skip to main content
SpringerLink
Log in

Nutrient Status 9 Years After Biliopancreatic Diversion with Duodenal Switch (BPD/DS): an Observational Study

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Since biliopancreatic diversion with duodenal switch (BPD/DS) produces hypoabsorption, evaluation of long-term nutrient changes is appropriate.

Methods

Measurements of micronutrients, trace elements, PTH, iron studies, and protein were completed for consented patients at baseline prior to surgery and at yearly intervals. The patients were advised and supplements were adjusted by blood studies with compliance checks. Independent t tests and ANOVAs compared changes between cross-sectional cohorts based on follow-up time from surgery. A p value of 0.05 was considered significant.

Results

Between 1999 and 2010, 284 patients had BPD/DS. At baseline, nutrient analysis was available for only 190 patients (70% women), age 42.7 ± 10.0 years, BMI 53.0 ± 11.9 kg/m2; at year 1, 189 were available; at year 3, 193; at year 5, 132; at year 7, 98; and at year 9, 68. Gender distribution was not significantly different between cohorts. Baseline vitamin D was low and PTH high. All of the patients took some supplements. Fat-soluble vitamins remained low. Protein deficiency appeared at year 3 and increased to 30% at year 9. Baseline zinc was normal, but at year 5, 45% were low. Over time, hematocrit was low for 40% and hemoglobin for 46%. Iron deficiency continued through year 9, more marked in males. Calcium deficiency increased from year 3 and remained steady. Half of the patients had abnormal PTH at baseline, and the percentage increased over time. Twenty percent had abnormal baseline magnesium values. Magnesium fluctuated during observation.

Conclusions

Major deficits in nutrient status occurred and persisted after surgery although supplementation was prescribed. Interventions are mandated to avoid nutrient deficiency.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Farrell TM, Haggerty SP, Overby DW, et al. Clinical application of laparoscopic bariatric surgery: an evidence-based review. Surg Endosc 2009; 23:930–949. PubMed

  2. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: systemic review and meta-analysis. J Am Med Assn. 2004;292:1724–37.

    Article  CAS  Google Scholar 

  3. Strain GW, Gagner M, Pomp A, et al. A comparison of weight loss (WL) and body composition (BC) changes with four surgical procedures. Surg Obes Relat Dis. 2009;5:582–7.

    Article  PubMed  Google Scholar 

  4. Marceau P, Biron S, Marceau S, et al. Long term metabolic outcomes 5 to 20 years after biliopancreatic diversion. Obes Surg. 2015; doi:10.1007/s 11695-015-1599-5.

    Google Scholar 

  5. Topart P, Becouarn G, Salle A. Five-year follow-up after biliopancreatic diversion with duodenal switch. Surg Obes Relat Dis. 2011;7:199–205.

    Article  PubMed  Google Scholar 

  6. Pata G, Crea N, Di Betta E, et al. Biliopancreatic diversion with transient gastroplasty and duodenal switch: long term results of a multicentric study. Surgery. 2013;153:413–22.

    Article  PubMed  Google Scholar 

  7. Hess DS, Hess DW, Oakley RS. The biliopancreatic diversion with the duodenal switch: results beyond 10 years. Obes Surgery. 2005;15:408–16.

    Article  Google Scholar 

  8. Crea N, Pata G, Di Betta E, et al. Long-term results of biliopancreatic diversion with or without gastric preservation for morbid obesity. Obes Surg. 2011;21:139–45.

    Article  PubMed  Google Scholar 

  9. Sethi M, Chau E, Youn A, et al. Long-term outcomes after biliopancreatic diversion with and without duodenal switch: 2-, 5-,and 10-year data. Surg Obes Relat Dis. 2016; doi:10.1016//j.soard.2016.03.006.

    Google Scholar 

  10. Strain GW, Torghabeh M, Gagner M, et al. The impact of the biliopancreatic diversion with the duodenal switch (BPD/DS) over 9 years. Obes Sur. 2016; doi:10.1007/s11695-016-2371-1.

    Google Scholar 

  11. Buchwald H, Orien DM. Metabolic/bariatric surgery worldwide 2011. Obesity Surg. 2013;23:427–36.

    Article  Google Scholar 

  12. Gagner M. Hypoabsorption not malabsorption, hypoabsorptive surgery and not malabsorptive surgery. Obes Surg. 2016 Aug 30; doi:10.1007/s11695-016-2350-6.

    Google Scholar 

  13. Anderson B, Gill RS, de Gara CJ, et al. Biliopancreatic diversion: the effectiveness of duodenal switch and its limitations. Gastroenterol Res Pract. 2013, Article ID:974762, 8 pp. PubMed

  14. Newbury L, Dolan K, Hatzifotis M, et al. Calcium and vitamin D depleted and elevated parathyroid hormone following biliopancreatic diversion. Obes Surg. 2003;13:893–5.

    Article  PubMed  Google Scholar 

  15. Risstad H, Savik TT, Engstrom M, et al. Five-year outcomes after laparoscopic gastric bypass and laparoscopic duodenal switch in patients with body mass index of 50-60: a randomized clinical trial. JAMA Surgery Feb 2–04 2015. Doi:10.1001/jamasurg.2014-3579.

  16. Homan J, Betzel B, Aarts EO, et al. Vitamin and mineral deficiencies after biliopancreatic diversion and biliopancreatic divrsion with duodenal switch—the rule rather than the exception. Obes Surg. 2015; doi:10.1007/s11695-015-1570-5.

    PubMed  Google Scholar 

  17. Topart P, Becouarn G, Salle A, et al. Biliopancreatic diversion requies multiple vitamin adjustments within 2 years of surgery. Surg Obes Relat Dis. 2014;10:936–43.

    Article  PubMed  Google Scholar 

  18. Isom KA, Andromatos I, Ariango M, et al. Nutrition and metabolic support recommendation for the bariatric patient. Nutr Clin Pract. 2014;29:718–39.

    Article  PubMed  Google Scholar 

  19. Marceau M, Biron S, Hould F-S, et al. Duodenal switch: long term results. Obes Surg. 2007;17:1421–30.

    Article  PubMed  Google Scholar 

  20. Ren CJ, Patterson E, Gagner M. Early results of laparoscopic biliopancreatic diversion with duodenal switch: a case series of 40 consecutive patients. Obes Surg. 2000;10:514–23.

    Article  CAS  PubMed  Google Scholar 

  21. Bailey RL, Fulgoni VLIII, Keast DR, et al. Dietary supplement use is associated with higher intakes of minerals from food sources. Am J Clini Nutr. 2011;94:1376–81.

    Article  CAS  Google Scholar 

  22. Saif T, Strain G, Gagner M, et al. An evaluation of nutrient status after laparoscopic sleeve gastrectomy 1, 3, and 5 years after surgery. Surg Obes Relat Dis. 2012;8:542–9.

    Article  PubMed  Google Scholar 

  23. Pracchand VN, DaVee RT, Alverdy JC. Duodenal switch provides superior weight loss in the super-obese (BMI>50 kg/m2) compared with gastric bypass. Ann Surg. 2006;244:611–9.

    Google Scholar 

Download references

Acknowledgments

We thank Dr. Paul Christos and Ms. Guojiao Wu, MS, for their assistance with the data analysis. They were partially supported by the following grant: Clinical and Translational Science Center at Weill Cornell Medical College (UL1-TR000457-06). The Department of Surgery at Weill Cornell School of Medicine supported this project.

Author Contributions

Conception and design: GWS, AP, and MG; patient recruitment and operative procedures: MG, AP, GD, DC, MHT, FE, and GWS; data collection: MHT, DC, EG, FE, and GWS; data analysis and interpretation: MHT, GWS, AP, and MG. All authors were involved in the development of the manuscript, edited, and approved this submission.

Author information

Authors and Affiliations

  1. Department of Surgery, Weill Cornell College of Medicine, 525 E 68th St, New York, NY, 10065, USA

    Gladys Witt Strain, Mehyar Hefazi Torghabeh, Faith Ebel, Gregory F. Dakin, Daniel Connolly, Elizabeth Goldenberg & Alfons Pomp

  2. Department of Surgery, Hopital du Sacre Coeur, Montréal, Canada

    Michel Gagner

Authors
  1. Gladys Witt Strain
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mehyar Hefazi Torghabeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michel Gagner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Faith Ebel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gregory F. Dakin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Daniel Connolly
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Elizabeth Goldenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Alfons Pomp
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gladys Witt Strain.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Strain, G.W., Torghabeh, M.H., Gagner, M. et al. Nutrient Status 9 Years After Biliopancreatic Diversion with Duodenal Switch (BPD/DS): an Observational Study. OBES SURG 27, 1709–1718 (2017). https://doi.org/10.1007/s11695-017-2560-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-017-2560-6

Keywords

Search

Navigation