LOS ANGELES – An increasing number of adolescents are undergoing gastric band removal after 2 years post operation, a prospective, longitudinal study shows.
“At 2 years most bands are still in place, with 96% of patients having them. After this point, however, multiple bands are removed each year, demonstrating that 2 years perhaps is only the tip of the iceberg,” Dr. Christine Schad said at Obesity Week.
Dr. Christine Schad
Indeed, the number of adolescents with bands in place reduced to 87%, 76%, and 53% at years 3, 4, and 5 of follow-up. After 5 years, patients continued to undergo band removal.
Like their adult counterparts, adolescents underwent band removal secondary to weight loss failure, reflux esophagitis, and refractory gastric prolapse, Dr. Schad of Morgan Stanley Children’s Hospital, New York-Presbyterian Columbia University Medical Center, New York, said.
Weight loss seemed to plateau over time among the 79 evaluable adolescents, with less than 39% of patients able to lose more than 50% of their excess body weight over the 5-year study.
“Although gastric banding can be performed safely, 2 years seems inadequate to evaluate efficacy,” she said.
The use of adjustable gastric banding rose rapidly after Food and Drug Administration approval in 2001, thanks to low perioperative morbidity, reversibility, and good early results.
Gastric banding has fallen sharply, however, with recent adult studies showing a high incidence of weight loss failure, weight regain, and device-related complications.
Previous studies have reported on the safety of laparoscopic adjustable gastric banding in adolescents; however, these studies are limited to 3-year follow-up at most, Dr. Schad said at the meeting presented by the Obesity Society and the American Society for Metabolic and Bariatric Surgery.
The investigators enrolled 137 morbidly obese adolescents, aged 14-18 years, who underwent laparoscopic adjustable gastric banding from 2006 to 2011. The current analysis included patients with at least 5 years follow-up and patients who had band removal at any point or who did not survive to study end. There were two deaths. The remaining patients had not reached the 5-year follow-up mark or still had their bands in place.
The 79 evaluable patients had a preoperative weight of 138 kg, body mass index of 49.3 kg/m2, and excess body weight of 47.2%. At the time of surgery, their average age was 16.9 years, 71% were female, 43% Hispanic, 36.7% white, and 16.5% black.
Even though gastric banding is declining, the results are important because there has been little information about adolescents, and in some parts of the country, gastric banding may be the only available option, session comoderator Dr. Robert Carpenter of Scott & White Healthcare in Temple, Tex., said in an interview.
“The other issue is that there are a lot of pediatricians that only want their patients to have nonstapled, nondivided operations,” he said. “If that’s the case, and we now know that perhaps for adolescents there is a 30%, 40%, 50% conversion and/or failure rate, then we are putting these kids at an extreme risk.”
Oftentimes, these adolescents also won’t have an opportunity for another operation.
“Many insurance companies that they’ll transition to away from their parents will actually have a complete exclusion for bariatric surgery or they have a onetime, lifetime operative opportunity,” Dr. Carpenter said. “So, if that’s been burned, it’s burned.”