Laparoscopic roux-en-Y gastric bypass versus sleeve gastrectomy for teenagers with severe obesity - TEEN-BEST: study protocol of a multicenter randomized controlled trial

Daniëlle S Bonouvrie,Edgar G A H Van Mil,Eric J Hazebroek,François M H Van Dielen,Arijan A P M Luijten,Anita C E Vreugdenhil,Wouter K G Leclercq,Andrew J Beamish,Torsten Olbers

doi:10.1186/s12893-020-00778-9

Abstract

BackgroundRecent data support the use of bariatric surgery in adolescents with severe obesity following unsuccessful non-surgical treatments. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) have demonstrated reasonably similar weight loss and reduction of obesity related comorbidities in randomized trials in adults. SG has internationally become the most commonly used procedure in adolescents, yet long-term outcome data are lacking. No randomized controlled trial comparing SG and RYGB has been performed in adolescents.ObjectiveDetermine whether SG is non-inferior to RYGB in terms of total body weight (TBW) loss in adolescents with severe obesity.MethodsA multicenter randomized controlled non-inferiority trial. Two hundred sixty-four adolescents aged 13–17 (Tanner stage ≥IV) with severe obesity (corrected for age and sex) will be included. Adolescents agreeing to participate will be randomized to either RYGB or SG. The primary outcome is the proportion of participants achieving 20% TBW loss at 3 years postoperatively. Secondary outcomes include (i) change in body weight, body mass index (BMI) and BMI standard deviation score, (ii) incidence of adverse health events and need for additional surgical intervention, (iii) resolution of obesity-related comorbidities, (iv) prevalence of cardio metabolic risk factor measures, (v) bone health measures and incidence of bone fractures, (vi) quality of life including psychosocial health, patient satisfaction and educational attainment and (vii) body composition. Follow-up will extend into the long term.ResultsNot applicable.DiscussionThis study will, to our knowledge, be the first randomized controlled trial comparing SG and RYGB in adolescents with severe obesity.Trial registrationThe trial is registered at the Netherlands Trial Register on July 26th, 2018 – NTR7191 - https://www.trialregister.nl/trial/7191 (protocol version 5.0 – February 3th 2020).

Highlights

MethodsTwo hundred sixty-four adolescents aged 13–17 (Tanner stage ≥IV) with severe obesity (corrected for age and sex) will be included
Recent data support the use of bariatric surgery in adolescents with severe obesity following unsuccessful non-surgical treatments
Obesity is a chronic disease associated with several comorbidities including Type 2 diabetes (T2D), cardiovascular disease, musculoskeletal disorders and some cancers [4]

Summary

Methods

Two hundred sixty-four adolescents aged 13–17 (Tanner stage ≥IV) with severe obesity (corrected for age and sex) will be included. Adolescents agreeing to participate will be randomized to either RYGB or SG. The primary outcome is the proportion of participants achieving 20% TBW loss at 3 years postoperatively. Secondary outcomes include (i) change in body weight, body mass index (BMI) and BMI standard deviation score, (ii) incidence of adverse health events and need for additional surgical intervention, (iii) resolution of obesity-related comorbidities, (iv) prevalence of cardio metabolic risk factor measures, (v) bone health measures and incidence of bone fractures, (vi) quality of life including psychosocial health, patient satisfaction and educational attainment and (vii) body composition. Follow-up will extend into the long term

Discussion

Background

Methods/design

Objective