Long-Term Metabolic Outcomes 5 to 20 Years After Biliopancreatic Diversion



Biliopancreatic diversion (BPD) is a complex bariatric operation requiring meticulous surveillance which has impeded its broad adoption. Improvements in surgical care and technique, better teaching programs, and stringent norms for follow-up have contributed to increased safety of BPD for patients with BMI <50, achieving better long-term results than other bariatric operations. Here we report 20-year outcomes of 2615 consecutive patients (median 8) having open BPD with duodenal switch (DS) between 1992 and 2010.


Chart of 92 % of patients with complete clinical, biochemical, and physical examinations completed before 2013 was reviewed. The research was conducted at Academic Medical Center, Quebec City.


There was total mortality of 4.7 %, equivalent to that of the general population of Quebec. Incident diabetes (38.8 %) was cured in 93.4 % (blood glucose <6 mmol/l; HbA1c <6.5 %) with 4 % relapse rate after mean 9.6 years with no new cases. Dyslipidemia (24.2 %) was cured in 80 %. Hypertension (60 %) was cured in 64 % and improved in 31 %. Mean weight loss of 55.3 kg (71 % excess weight loss (EWL); 20 BMI units) was maintained for 5 to 20 years. Operative mortality was reduced from 1.3 % in 1992 to 0.2 % during 2005–2010, with cumulated rate surgical mortality of 0.5, revision rate 3, and reoperations in 13 %. Nutritional deficiencies were present in 2 % for calcium, iron, and vitamin A. Side effects were considered minor by the great majority of patients, rating global satisfaction as 4.5/5 (91 % “satisfied”).


BPD deserves more consideration as a primary procedure for eligible patients in experienced centers with sufficient resources for delivering high-quality care and long-term follow-up.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5


  1. 1.

    Scopinaro N, Gianetta E, Civalleri D, et al. Bilio-pancreatic bypass for obesity: II. Initial experience in man. Br J Surg. 1979;66:618–20.

    CAS  PubMed  Article  Google Scholar 

  2. 2.

    Scopinaro N, Gianetta E, Adami GF, et al. Biliopancreatic diversion for obesity at eighteen years. Surgery. 1996;119:261–8.

    CAS  PubMed  Article  Google Scholar 

  3. 3.

    Scopinaro N, Adami GF, Marinari GM, et al. Biliopancreatic diversion. World J Surg. 1998;22:933–46.

    Article  Google Scholar 

  4. 4.

    Scopinaro N, Marinari GM, Camerini GB, et al. Specific effects of biliopancreatic diversion on the major components of metabolic syndrome: a long-term follow-up study. Diabetes Care. 2005;28:2406–11.

    PubMed  Article  Google Scholar 

  5. 5.

    Adami G, Murelli F, Carlini F, et al. Long-term effect of biliopancreatic diversion on blood pressure in hypertensive obese patients. Am J Hypertens. 2005;18:780–4.

    PubMed  Article  Google Scholar 

  6. 6.

    Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122:248–56.

    PubMed  Article  Google Scholar 

  7. 7.

    Marceau S, Biron S, Lagacé M, et al. Biliopancreatic diversion, with distal gastrectomy, 250 cm and 50 cm limbs : long-term results. Obes Surg. 1995;5:302–7.

    PubMed  Article  Google Scholar 

  8. 8.

    Marceau P, Biron S, Bourque RA, et al. Biliopancreatic diversion with a new type of gastrectomy. Obes Surg. 1993;3:29–35.

    PubMed  Article  Google Scholar 

  9. 9.

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

    PubMed  Article  Google Scholar 

  10. 10.

    Marceau P, Biron S, Hould FS, et al. Duodenal switch: long term results. Obes Surg. 2007;17:1421–30.

    PubMed  Article  Google Scholar 

  11. 11.

    Biron S, Hould FS, Lebel S, et al. Twenty years of BPD: what is the goal of the surgery. Obes Surg. 2004;14:160–4.

    PubMed  Article  Google Scholar 

  12. 12.

    National Institute of Health Consensus Development Conference statement. Gastrointestinal surgery for morbid obesity. Am J Clin Nutrition. 1992;55:615S–9.

    Google Scholar 

  13. 13.

    Dr. Aly Abbara. Formule de calcul de surface corporelle (http://www.aly-abbara.com) Wang : mean of mean female + mean of mean male/2 = 23

  14. 14.

    Life tables, Canada, provinces and territories 2007–2009. WWW.statcan.qc.ca/pub 84-537-x/84-537-x2013003-fra-htm.

  15. 15.

    Marceau P, Biron S, Hould FS, et al. Liver pathology and the metabolic syndrome X in severe obesity. J Clin Endocrinol Metabol. 1999;84:1513–7.

    CAS  Article  Google Scholar 

  16. 16.

    Kral JG, Thung SN, Biron S, et al. Effects of surgical treatment of the metabolic syndrome on liver fibrosis and cirrhosis. Surgery. 2004;135:48–58.

    PubMed  Article  Google Scholar 

  17. 17.

    Takamiya T, Zaky WR, Edmundowics D, et al. World Health Organization-defined metabolic syndrome is a better predictor or coronary calcium than the adult treatment panel III criteria in American men aged 40–49 years. Diabetes Care. 2004;12:2977–9.

    Article  Google Scholar 

  18. 18.

    Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998;7:539–53.

    Article  Google Scholar 

  19. 19.

    Kral JG. Diabesity: palliating, curing or preventing the dysmetabolic diathesis. Maturitas. 2014;77:243–8.

    PubMed  Article  Google Scholar 

  20. 20.

    Marceau P, Kaufman D, Biron S, et al. Outcome of pregnancies after bilio-pancreatic diversion. Obes Surg. 2004;14:318–24.

    PubMed  Article  Google Scholar 

  21. 21.

    Kral JG, Biron S, Simard S, et al. Large maternal weight loss from obesity surgery prevents transmission of obesity to children who were followed for 2 to 18 years. Pediatrics. 2006;118:1644–9.

    Article  Google Scholar 

  22. 22.

    Smith J, Cianflone K, Biron S, et al. Effects of maternal surgical weight loss in mothers on intergenerational transmission of obesity. J Clin Endocrinol Metab. 2009;94:4275–83.

    CAS  PubMed  Article  Google Scholar 

  23. 23.

    Guenard F, Deshaies Y, Cianflone K, et al. Differential methylation in glucoregulatory genes of offspring born before vs after maternal gastrointestinal bypass surgery. PNAS. 2013;110:11439–44.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  24. 24.

    Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;23(357):753–61.

    Article  Google Scholar 

  25. 25.

    Flum DR, Dellinger EP. Impact of gastric bypass operation on survival: a population-based analysis. J Am Coll Surg. 2004;199:543–51.

    PubMed  Article  Google Scholar 

  26. 26.

    Calle EE, Thun MJ, Petrelli JM, et al. Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med. 1999;341:1097–105.

    CAS  PubMed  Article  Google Scholar 

  27. 27.

    Katzmarzyk PT, Craig CL, Bouchard C. Underweight, overweight and obesity: relationships with mortality in the 13-year follow-up of the Canada Fitness Survey. J Clin Epidemiol. 2001;54:916–20.

    CAS  PubMed  Article  Google Scholar 

  28. 28.

    Sjostrom L, Narbro K, Sjostrom CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741–52.

    PubMed  Article  Google Scholar 

  29. 29.

    Fontaine KR, Redden DT, Wang C, et al. Years of life lost due to obesity. JAMA. 2003;289:187–93.

    PubMed  Article  Google Scholar 

  30. 30.

    Finkelstein EA, Brown DS, Wrage LA, et al. Individual and aggregate years-of-life-lost associated with overweight and obesity. Obesity. 2010;18:333–9.

    PubMed  Article  Google Scholar 

  31. 31.

    Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222:339–50.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  32. 32.

    Junquero D, Rival Y. Syndrome métabolique: quelle définition pour quel (s) traitement (s) ? Med Sci (Paris). 2005;12:1045–53.

    Article  Google Scholar 

  33. 33.

    Skroubis G, Kouri N, Mead N, et al. Long-term results of a prospective comparison of Roux-en-Y gastric bypass versus a variant of biliopancreatic diversion in a non-superobese population (BMI 35–50 kg/m(2)). Obes Surg. 2014;24:197–204.

    PubMed  Article  Google Scholar 

  34. 34.

    Edholm D, Svensson F, Naslund I, et al. Long-term results 11 years after primary gastric bypass in 384 patients. Surg Obes Relat Dis. 2013;9:708–13.

    PubMed  Article  Google Scholar 

  35. 35.

    Sjostrom CD, Peltonen M, Sjostrom L. Blood pressure and pulse pressure during long-term weight loss in the obese: the Swedish Obese Subjects (SOS) Intervention Study. Obes Res. 2001;9:188–95.

    CAS  PubMed  Article  Google Scholar 

  36. 36.

    Hedberg J, Sundstrom J, Sundbom M. Duodenal switch versus Roux-en-Y gastric bypass for morbid obesity: systemic review and meta-analysis of weight results, diabetes resolution and early complications in single-center comparisons. Obes Rev. 2014;15:555–63.

    CAS  PubMed  Article  Google Scholar 

  37. 37.

    Biertho L, Biron S, Hould FS, et al. Is biliopancreatic diversion with duodenal switch indicated for patients with body mass index <50 kg/m2. Surg Obes Relat Dis. 2010;6:508–14.

    PubMed  Article  Google Scholar 

  38. 38.

    Biertho L, Lebel S, Marceau S, et al. Perioperative complications in a consecutive series of 1000 duodenal switches. Surg Obes Relat Dis. 2013;9:63–8.

    PubMed  Article  Google Scholar 

  39. 39.

    Marceau P, Biron S, Lebel S, et al. Does bone change after biliopancreatic diversion. J Gastrointest Surg. 2002;6:690–8.

    PubMed  Article  Google Scholar 

Download references


The authors would like to acknowledge Paule Marceau, Databank manager, who assisted us the data collection.

Authors’ contributions

Picard Marceau and Simon Marceau have full access to all of the data and take responsibility for the integrity and accuracy of the data. John G. Kral, co-writer supervisor, was participated in the conception, revision, and approval of the study. Biron S., Hould F.S., Lebel S., Lescelleur O., and Biertho L., bariatric surgeons, were participated in the revision and approval of the study. Simard S. was the research statistician from IUCPQ Research Center.

Conflict of Interest

All authors have no financial relationships relevant to this article to disclose.

A Statement of Informed Consent

Informed consent was obtained from all individual participants included in the study. Databank and its use for research have been accepted by the Laval University, University Institute of Cardiology and Pneumology of Quebec (IUCPQ).

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Author information



Corresponding author

Correspondence to Picard Marceau.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Marceau, P., Biron, S., Marceau, S. et al. Long-Term Metabolic Outcomes 5 to 20 Years After Biliopancreatic Diversion. OBES SURG 25, 1584–1593 (2015). https://doi.org/10.1007/s11695-015-1599-5

Download citation


  • Duodenal switch
  • Bariatric surgery
  • Metabolic surgery
  • Outcomes
  • “Health care delivery”