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Background <p> Duodenal switch (DS) can be performed as a direct one-stage procedure or as a planned/revisional two-step approach after sleeve gastrectomy. Consistent head-to-head evidence on long-term disease-free time is limited.</p> Objectives <p> To compare disease-free time and safety between direct (one-stage) and two-step DS.</p> Setting <p> Spanish tertiary bariatric center.</p> Methods <p>Propensity-score matched analysis (1:1) of patients undergoing DS, comparing direct versus two-step procedures. Matching variables were age, sex, and baseline body mass index (BMI). From 429 DS cases, 75 direct DS patients were matched to 75 two-step patients. Outcomes included short- and long-term complications, mortality, severe diarrhea or malnutrition, follow-up completeness at 3 and 5 years, weight loss, BMI &lt; 35&#xa0;kg/m², and disease-free status operationalized as the absence of metabolic diseases across follow-up.</p> Results <p> Mean initial BMI was 55.9 kg/m². Safety was comparable: short-term complications 14% (6% Clavien–Dindo ≥ III) and long-term 5.3%, with no between-group differences; no mortality, severe diarrhea, or malnutrition.Follow-up was 94.6% at 3 years and 80.7% at 5 years. Direct DS showed superior disease-free status at 5 years (absence of metabolic diseases 66.7% vs 57.1%; p&lt;0.001) and greater durability of weight control (BMI &lt; 35 kg/m² 88.2% vs 71.4%; p&lt;0.001), along with higher total weight loss (45.4% vs 42.0%; p&lt;0.05).</p> Conclusions <p> In patients with BMI &gt; 50 kg/m², direct DS achieves longer high-risk disease-free status while maintaining a safety profile comparable to two-step DS.</p>

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Time Free from High-Risk Obesity after One-Step Vs. Two-Step Duodenal Switch: A Propensity-Score Single-Center Analysis

  • 期刊论文

  • 发表日期：

    2026年1月6日

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  • Javier Osorio,
  • David Merino,
  • Lucia Sobrino,
  • Nuria Vilarrasa,
  • Ana Almeida,
  • Amador García-Ruiz-de-Gordejuela,
  • Ainitze Ibarzabal,
  • Claudio Lazzara

摘要

Background

Duodenal switch (DS) can be performed as a direct one-stage procedure or as a planned/revisional two-step approach after sleeve gastrectomy. Consistent head-to-head evidence on long-term disease-free time is limited.

Objectives

To compare disease-free time and safety between direct (one-stage) and two-step DS.

Setting

Spanish tertiary bariatric center.

Methods

Propensity-score matched analysis (1:1) of patients undergoing DS, comparing direct versus two-step procedures. Matching variables were age, sex, and baseline body mass index (BMI). From 429 DS cases, 75 direct DS patients were matched to 75 two-step patients. Outcomes included short- and long-term complications, mortality, severe diarrhea or malnutrition, follow-up completeness at 3 and 5 years, weight loss, BMI < 35 kg/m², and disease-free status operationalized as the absence of metabolic diseases across follow-up.

Results

Mean initial BMI was 55.9 kg/m². Safety was comparable: short-term complications 14% (6% Clavien–Dindo ≥ III) and long-term 5.3%, with no between-group differences; no mortality, severe diarrhea, or malnutrition.Follow-up was 94.6% at 3 years and 80.7% at 5 years. Direct DS showed superior disease-free status at 5 years (absence of metabolic diseases 66.7% vs 57.1%; p<0.001) and greater durability of weight control (BMI < 35 kg/m² 88.2% vs 71.4%; p<0.001), along with higher total weight loss (45.4% vs 42.0%; p<0.05).

Conclusions

In patients with BMI > 50 kg/m², direct DS achieves longer high-risk disease-free status while maintaining a safety profile comparable to two-step DS.