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Bile Reflux After Single Anastomosis Duodenal-Ileal Bypass with Sleeve (SADI-S): a Meta-analysis of 2,029 Patients

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Abstract

Background

Single anastomosis duodenal-ileal bypass with sleeve (SADI-S) is a novel bariatric surgery modified from the classic biliopancreatic diversion with duodenal switch (BPD-DS). These surgical modifications address most BPD-DS hurdles, but the risk of bile reflux may hinder SADI-S acceptance. We aimed to evaluate the event rate of bile reflux after SADI-S.

Methods

PubMed, ScienceDirect, Cochrane, Web of Science, and Google Scholar were used to search English articles between 2008 and 2021 by two independent reviewers using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). The risk of bias was assessed using Newcastle–Ottawa Scale and the JBI tool. Event rates were meta-analyzed using Comprehensive Meta-Analysis (CME) V3.

Results

Out of 3,027 studies analyzed, seven were included. Studies were published between 2010 and 2020. Six out of 7 studies were retrospective. Three studies had a low risk of bias, three studies had a moderate risk of bias, and one had a high risk of bias. The mean follow-up was 10.3 months. The total number of patients was 2,029, with 25 reports of bile reflux, resulting in an incidence of 1.23%, with an event rate of 0.016 (95% CI 0.004 to 0.055).

Conclusions

Bile reflux has not been demonstrated to be problematic after SADI-S in this meta-analysis. Further long-term studies are needed.

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Authors and Affiliations

  1. Department of Surgery, Mayo Clinic, Rochester, MN, 55905, USA

    Ray Portela, Ahmet Vahibe & Omar M. Ghanem

  2. Carle Foundation Hospital General Surgery Residency, Champaign, IL, USA

    Katie Marrerro

  3. Department of Surgery, Tulane School of Medicine, New Orleans, LA, USA

    Carlos Galvani

  4. Ventura Advanced Surgical Associates, Ventura, CA, USA

    Helmuth Billy

  5. Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, USA

    Barham Abu Dayyeh

  6. Department of Surgery, Texas Tech HSC Paul Foster School of Medicine, El Paso, TX, USA

    Benjamin Clapp

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  1. Ray Portela
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Corresponding author

Correspondence to Omar M. Ghanem.

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Conflict of Interest

Ray Portela, Katie Marrero, Ahmet Vahibe, Benjamin Clapp, and Omar Ghanem have no competing interests. Carlos Galvani has received speaker honorarium from Intuitive Surgical, WL Gore, and BD. Helmuth Billy has received speaker honorarium from Medtronic and advisory panel/board honorarium from Standard Bariatrics; consulting fee from Lexion and Lexington Medical; and equity/ownership from GT Metabolic. Barham Abu Dayyeh has received consulting fee from Endogenex, Endo-TAGSS, Metamodix, and BFKW; consulting fee and grant/research support from USGI, Cairn Diagnostics, Aspire Bariatrics, and Boston Scientific; speaker honorarium from Olympus and Johnson and Johnson; speaker honorarium and grant/research support from Medtronic and EndoGastric Solutions; and research support/grant from Apollo Endosurgery and Spatz Medical.

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Key Points

1. Bile reflux is a rarely reported event after SADI-S.

2. The risk of bias was low to moderate in the majority of the studies.

3. The lack of long-term follow-up and the diagnostic difficulty could have led to underprediction.

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Portela, R., Marrerro, K., Vahibe, A. et al. Bile Reflux After Single Anastomosis Duodenal-Ileal Bypass with Sleeve (SADI-S): a Meta-analysis of 2,029 Patients. OBES SURG 32, 1516–1522 (2022). https://doi.org/10.1007/s11695-022-05943-y

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  • DOI: https://doi.org/10.1007/s11695-022-05943-y

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