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Drug Dosing: Obese Patients01:21

Drug Dosing: Obese Patients

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In the United States, obesity is a prominent concern. It is linked to heightened mortality rates due to increased occurrences of conditions such as hypertension, atherosclerosis, coronary artery disease, and diabetes compared to nonobese individuals. A patient is classified as obese if their actual body weight surpasses the ideal or desirable body weight by 20%, based on Metropolitan Life Insurance Company data. Ideal body weights consider average weights and heights for males and females...
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Pharmacokinetics in Obese Patients: Drug Metabolism and Excretion01:20

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Drug metabolism, a critical process in the liver, involves two primary phases: Phase I reactions and Phase II conjugation. Obesity introduces significant alterations in this metabolic process, primarily due to fatty infiltration of the liver, leading to conditions such as nonalcoholic fatty liver disease (NAFLD). This condition can modify the activities of both Phase I and II enzymes, impacting how drugs are metabolized in obese patients.Phase I metabolism sees variable effects across...
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Obesity01:24

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The Body Mass Index (BMI) is a numerical value derived from a person's weight and height, used to categorize individuals into weight ranges. It is calculated using the formula: weight in kilograms divided by height in meters squared. Obesity is a health condition characterized by excessive accumulation of adipose tissue that poses health risks, often diagnosed with a BMI ≥ 30. This excess fat storage occurs when surplus dietary calories are converted into triglycerides and stored in...
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Pharmacokinetics in Obese Patients: Drug Absorption and Distribution01:25

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Obesity significantly alters the pharmacokinetic processes of drug absorption and distribution, presenting unique challenges in medical treatment. The increased fat tissue and decreased lean muscle in obese individuals can significantly affect how drugs are absorbed into the body and distributed across different tissues. This alteration can lead to variances in the effectiveness and safety of medications, necessitating adjustments in dosing or drug selection for obese patients.One notable...
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Correction: Patient-Reported Outcomes and Quality of Life After Single-Anastomosis Duodeno-ileal Bypass with Sleeve Gastrectomy (SADI-S): a Cross-Sectional Study with 283 Patients from a Single Institution.

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

Javier Osorio1, David Merino2, Lucia Sobrino3

  • 1Hospital Clínic de Barcelona, Barcelona, Spain. josorio@clinic.cat.

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|January 6, 2026
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Summary

Direct duodenal switch (DS) offers superior long-term disease-free status and weight control compared to the two-step approach in patients with high BMI. Safety profiles remain comparable between both bariatric surgery methods.

Keywords:
Bariatric surgeryDuodenal switchHypoabsorptive surgeryObesityRevisional bariatric surgery

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Area of Science:

  • Bariatric surgery
  • Metabolic surgery
  • Surgical outcomes

Background:

  • Duodenal switch (DS) can be performed as a one-stage direct procedure or a two-step approach following sleeve gastrectomy.
  • Limited head-to-head data exists comparing long-term disease-free outcomes between these DS methods.

Purpose of the Study:

  • To compare disease-free time and safety between direct (one-stage) and two-step duodenal switch (DS) procedures.
  • Evaluate long-term efficacy and safety of different DS approaches in patients with severe obesity.

Main Methods:

  • A propensity-score matched analysis compared 75 direct DS patients with 75 two-step DS patients.
  • Matching criteria included age, sex, and baseline body mass index (BMI).
  • Outcomes assessed were complications, mortality, severe diarrhea, malnutrition, follow-up rates, weight loss, and disease-free status at 3 and 5 years.

Main Results:

  • Both direct and two-step DS demonstrated comparable safety profiles with similar short- and long-term complication rates and no mortality, severe diarrhea, or malnutrition.
  • Direct DS showed significantly superior disease-free status at 5 years (66.7% vs 57.1%) and more durable weight control (BMI < 35 kg/m²: 88.2% vs 71.4%).
  • Direct DS also resulted in greater total weight loss (45.4% vs 42.0%).

Conclusions:

  • Direct duodenal switch (DS) is a safe and effective option for patients with BMI > 50 kg/m².
  • Direct DS achieves longer high-risk disease-free status and more durable weight control compared to the two-step approach.
  • The safety profile of direct DS is comparable to the two-step DS procedure.