Long-Term Effects of Biliopancreatic Diversion (BPD), Biliopancreatic Diversion with Duodenal Switch (BPD-DS), and Single Anastomosis Duodeno‑Ileal Bypass with Sleeve Gastrectomy (SADI‑S) in Patients with Obesity: A Meta-Analysis.
Shahriar Azizi, Mohammad Mehdi Zare, Sherko Abbas Nadir et al.
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In 30 seconds
This systematic review and meta-analysis assessed outcomes at 10 or more years after biliopancreatic diversion (BPD), BPD with duodenal switch (BPD-DS), and single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) in people with obesity. Across 22 studies and 2,156 patients, BPD and BPD-DS were associated with a mean BMI reduction of 19.02 kg/m². BPD-DS achieved 36.34% total weight loss, while long-term metabolic benefits were accompanied by nutritional complications. Evidence for SADI-S came from only two studies and suggested sustained weight loss, with reoperations for nutritional complications also reported.
Key findings
- BPD and BPD-DS were associated with a mean BMI reduction of 19.02 kg/m²; BPD-DS total weight loss was 36.34%.
- After BPD and BPD-DS, reported resolution rates were 78% for diabetes, 63% for hypertension, 83% for hyperlipidemia, and 89% for obstructive sleep apnea.
- Long-term complications included anemia in 19%, iron deficiency in 34%, bone disorders in 25%, and revision surgery in 3%.
- In two SADI-S studies, total weight loss was 34.4% and excess weight loss was 80.4%; reoperations for nutritional complications were notable.
Why it matters
The findings indicate that substantial long-term weight loss and metabolic improvement after BPD and BPD-DS can coexist with clinically important nutritional and bone complications. This balance is relevant when weighing long-term outcomes of bariatric procedures and underscores the importance of sustained follow-up. The evidence for SADI-S is less extensive, so its long-term benefits and risks are less certain.
What to keep in mind
Long-term SADI-S evidence was limited to two studies. The review included studies with differing procedures and compared outcomes across studies, rather than reporting a single randomised comparison.