Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 4 appraisals
Medicine
Clinical outcome of revisional gastrectomy postgastric banding failure: A systematic review.
BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) has been widely used for obesity management; however, its long-term failure, due to complications such as band erosion, slippage, and inadequate weight loss, has necessitated revisional bariatric procedures. Revisional laparoscopic sleeve gastrectomy has emerged as a common alternative, yet its safety and efficacy remain debated. METHODS: A systematic review was conducted in accordance with PRISMA guidelines; this review was prospectively registered with Prospective Register of Systematic Reviews (CRD42024568094). A comprehensive search of PubMed, Scopus, Web of Science, and Cochrane databases was performed up to July 19, 2024. Studies published in English that reported postoperative outcomes following revisional laparoscopic sleeve gastrectomy after failed LAGB were included. Data were extracted independently by 2 reviewers, focusing on patient demographics, complication rates (including leaks, bleeding, and infections), and nutritional outcomes. Quality assessment was performed using a standardized tool for observational studies, cohort and cross-sectional studies. RESULTS: Fifty studies involving a total of 16,192 patients were analyzed. Patients had a mean age between 30 and 50 years and a revision body mass index ranging from 33 to 52 kg/m2. Infection was reported in 9 studies, though incidence was low. Bleeding was examined in 30 studies, with mostly isolated cases; thrombosis was reported in only 1 study. Leak rates were reported in 39 studies, ranging from 0% to 8.1%, with stage-specific rates between 2.8% and 5.8%. Four studies noted nutritional deficiencies, including increased ferritin deficiency and some cases contributing to readmission. Overall complication rates were reported in 22 studies, averaging 9.95% and ranging from 0% to 37.5%. CONCLUSION: Revisional laparoscopic sleeve gastrectomy following failed LAGB appears to offer a safe and effective alternative, with acceptable complication rates and favorable weight loss outcomes. However, heterogeneity in study designs and patient characteristics underscores the need for standardized reporting and further research to optimize clinical protocols.
28 June 2026
Read appraisal →PloS one
The application of large language models in bariatric surgery: A scoping review
BACKGROUND: Exploratory applications of large language models within the specialized field of metabolic and bariatric surgery have begun to emerge. Nevertheless, existing research remains fragmented, lacking comprehensive integration. OBJECTIVE: To conduct a scoping review of studies on the application of large language models in the field of metabolic and bariatric surgery, aiming to provide a reference for clinical practice and future research. METHODS: This scoping review adhered to the Joanna Briggs Institute methodological framework and followed the preferred reporting items for systematic reviews and meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines.PubMed, Web of Science, The Cochrane Library, Embase, CINAHL, CNKI, Wanfang, and VIP databases were searched for relevant studies, with the search timeframe from database inception to November 2025. The included literature was summarized and analyzed. RESULTS: A total of 21 English-language studies were included. LLMs were primarily applied in scenarios such as patient education and information consultation, clinical decision support, and professional knowledge assessment. While LLMs performed well in information-provision tasks, they showed low consistency with expert opinions in complex clinical tasks such as individualized surgical recommendations. Performance varied across different models, with GPT-4 generally demonstrating superior performance, and domain-specific models showing professional potential. Current research still faces challenges regarding information accuracy, readability, and clinical applicability. CONCLUSION: Large language models hold auxiliary potential in the field of metabolic and bariatric surgery, particularly for knowledge dissemination and patient education. However, their reliability in complex clinical decision-making remains limited. Future efforts should focus on conducting high-quality studies, advancing model specialization and standardized evaluation, and exploring safe and effective human-AI collaboration models.
7 June 2026
Read appraisal →The Journal of clinical endocrinology and metabolism
Sustained Action of Imapextide, A Glucagon-Like Peptide-1 Receptor Antagonist, in Healthy Volunteers
CONTEXT: After weight-loss surgery, some patients experience postbariatric hypoglycemia (PBH). Although PBH is customarily managed by dietary modifications with continuous glucose monitoring, advanced treatment options are needed. Imapextide is a sustained-action, selective, reversible glucagon-like peptide-1 (GLP-1) receptor antagonist designed for once-weekly administration for PBH treatment. OBJECTIVE: This work aimed to evaluate safety, tolerability, pharmacokinetics (PK), and pharmacodynamics (PD) of single and multiple ascending doses (SAD/MAD) of imapextide in healthy volunteers (HVs). METHODS: This 3-part, phase 1, double-blind study enrolled healthy adults. In the SAD/MAD parts, randomly assigned participants (3:1) received subcutaneous imapextide (SAD, 10-200 mg; MAD, 10-30 mg once weekly, 4 doses) or placebo. The primary end point was safety/tolerability (treatment-emergent adverse events [TEAEs]). PK (SAD/MAD; time-to-maximal concentration [tmax] and half-life [t1/2]) and PD (MAD; GLP-1 and glycemic parameters during a mixed meal tolerance test [MMTT]) were assessed. Imapextide drug-drug interactions (DDIs) of OATP1B1/OATP1B3 inhibition and accelerated gastric emptying were evaluated with coproporphyrin-I, rosuvastatin, and acetaminophen. RESULTS: Overall, 69 HVs were randomly assigned (32 SAD, 23 MAD, 14 DDIs). Imapextide TEAE rates ranged from 33.3% to 50.0% (SAD), 33.3% to 100% (MAD), and 14.3% (DDIs) across cohorts. The most common TEAEs included injection site erythema (SAD, MAD) and injection site swelling (MAD). Imapextide exposure was dose proportional (median tmax 24-48 hours; mean t1/2 ∼90 hours). During the MMTT, imapextide increased GLP-1 concentrations at early time points, while effects on other glycemic parameters were variable. Minimal nonclinically relevant DDIs occurred with rosuvastatin. Imapextide slightly accelerated gastric emptying. CONCLUSION: Imapextide was generally well tolerated in HVs. PK findings supported weekly dosing. PD showed consistent effects on GLP-1 levels, supporting a potential role for imapextide in modulating PBH pathophysiology.
21 May 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Effectiveness of prehabilitation strategies in enhancing recovery and postoperative outcomes in laparoscopic sleeve gastrectomy patients
OBJECTIVE: This study aims to explore the application of a multimodal prehabilitation strategy in patients undergoing laparoscopic sleeve gastrectomy (LSG) and to evaluate its impact on postoperative recovery, weight loss, and quality of life. METHODS: This was a single-center, prospective, randomized controlled trial. A total of 120 eligible patients undergoing elective LSG were enrolled and randomly assigned to either the control group (n = 60), receiving routine perioperative care, or the observation group (n = 60), receiving a structured 5-7-day prehabilitation program. RESULTS: Compared to the control group, the observation group had a significantly shorter postoperative hospital stay (mean difference [MD] -1.23 days; 95% CI -1.67 to -0.79; P < 0.001) and a lower incidence of complications (1.7% vs. 11.7%; odds ratio 0.13, 95% CI 0.02-0.89; P = 0.038). At 6 months, the prehabilitation group showed a greater reduction in BMI (MD -3.78 kg/m2; 95% CI -5.10 to -2.46; P < 0.001) and higher quality of life scores across all eight SF-36 domains (P < 0.001 for all). CONCLUSION: The application of prehabilitation strategies in patients undergoing laparoscopic sleeve gastrectomy can effectively promote faster postoperative recovery, enhance weight loss, improve quality of life, and reduce the incidence of postoperative complications. It is a safe and effective approach, worthy of clinical promotion. Furthermore, the principles of this multimodal prehabilitation framework offer valuable translational insights for optimizing perioperative supportive care in surgical oncology.
12 Apr 2026
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