What does this research mean for the field?

Direct duodenal switch achieves superior disease-free status at 5 years (66.7% vs 57.1%) compared to the two-step approach in patients with BMI > 50 kg/m². Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

What question did this study set out to answer?

To evaluate the disease-free time and safety outcomes of one-stage compared to two-step duodenal switch procedures.

January 10, 2026Obesity Surgery0 citations

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

JOJavier OsorioBellvitge University Hospital DMDavid MerinoBellvitge University Hospital LSLucía SobrinoBellvitge University Hospital

Key Result

Direct duodenal switch achieved superior disease-free status at 5 years (66.7% vs 57.1%, p<0.001) compared to two-step approach in patients with BMI > 50 kg/m².

Key Points

To evaluate the disease-free time and safety outcomes of one-stage compared to two-step duodenal switch procedures.
Propensity-score matched analysis of patients undergoing duodenal switch, comparing one-stage and two-step procedures.
Matched variables included age, sex, and baseline body mass index (BMI).
Total of 429 cases analyzed; 75 patients in each group after matching.
Outcomes assessed included complications, mortality, weight loss, BMI, and metabolic disease status at follow-up.
Both procedures had similar safety profiles with short-term complications at 14% and long-term at 5.3%.
Direct duodenal switch showed a higher disease-free status at 5 years (66.7% vs 57.1%; p<0.001).
Greater durability of weight control observed in direct procedure (BMI < 35 kg/m²: 88.2% vs 71.4%; p<0.001).
Total weight loss was greater in the direct group (45.4% vs 42.0%; p<0.05).

Structured PICO

Does direct (one-stage) duodenal switch improve disease-free status and weight loss compared to two-step duodenal switch in patients with severe obesity?

Population

150 patients (75 matched pairs from an initial pool of 429 cases) undergoing duodenal switch with mean initial BMI 55.9 kg/m² at a Spanish tertiary bariatric center.

Intervention

Direct (one-stage) duodenal switch

Comparator

Two-step duodenal switch (planned/revisional approach after sleeve gastrectomy)

Outcome

Disease-free status operationalized as the absence of metabolic diseases across follow-upcomposite

In patients with severe obesity, direct one-stage duodenal switch achieves longer metabolic disease-free status and better weight control at 5 years compared to a two-step approach, with comparable safety.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

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

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