Single-anastomosis Duodeno Ileal Bypass (SADI) Versus Roux-en-Y Gastric Bypass

NCT ID: NCT03610256

Last Updated: 2025-09-09

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

382 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-10-18

Study Completion Date

2023-12-04

Brief Summary

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Obesity is a major public health problem worldwide. Bariatric surgery has proved to be the most effective treatment of morbid obesity in terms of weight reduction and remission of co-morbid conditions during long-term follow-up. Nowadays, France is ranked 3rd in terms of bariatric surgeries performed per year.

Since the laparoscopic Roux-en-Y gastric bypass (RYGB) was described in 1977, this restrictive and malabsorptive procedure has become a gold standard for morbid obesity with an average Excess Weight Loss % (EWL%) of 72% at 2 years, and a strong metabolic effect, especially with regard to type 2 diabetes remission. Nevertheless, failures are observed (up to 20%), particularly in super obese patients, which are then difficult to manage. In this population, biliopancreatic diversion with duodenal switch (BPD-DS) is indicated due to its stronger weight loss and metabolic effect, but is still little performed worldwide because of its higher morbidity, surgical complexity and risk of malnutrition.

A novel technique combining the physiological advantages of pylorus preservation and the technical benefits of single-loop reconstruction was introduced in 2007 by Sanchez-Pernaute, who described the single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) as an evolution of the BPD-DS. With a 2.5-meter common channel, SADI-S seems to offer good results for the treatment of both morbid obesity and its metabolic complications, with an EWL% of up to 95% at 2 years and potentially less nutritional consequences.

To date, there is only one Spanish randomized trial comparing SADI-S to BPD-DS, whereas BPD-DS represents less than 1% of bariatric procedures in France and is only allowed in super obese patients. Thus only preliminary data of poor scientific value exists. Nevertheless, facing very encouraging short-term outcomes, there is a real need for a prospective trial comparing SADI-S to a standard bariatric procedure.

The aim of the investigator's study is to assess weight loss efficiency and the morbi-mortality of the SADI-S in comparison to a standard (RYGB), in order to validate this procedure among bariatric techniques

HYPOTHESIS SADI-S is superior to the standard RYGB for weight loss, increasing the EWL% by 10% (82% vs 72%, respectively) at 2 years.

Detailed Description

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Conditions

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Obesity, Morbid

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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SADI-S

This corresponds to obese patients (BMI ≥40 kg/m2 or BMI ≥35 kg/m2 +/- co-morbidities (high blood pressure, dyslipidemia, obstructive sleep apnea, type 2 diabetes mellitus, arthrosis)) benefiting from a laparoscopic SADI-S (laparoscopic Single-anastomosis duodeno ileal bypass with Sleeve gastrectomy).

SADI-S will be performed as a primary procedure or after failure of sleeve gastrectomy, defined as insufficient weight loss at 18 months after surgery (EWL% \<50), or as weight regain (+ 20% of nadir weight).

Group Type EXPERIMENTAL

SADI-S

Intervention Type PROCEDURE

Laparoscopic SADI-S, recently described as an evolution of the BPD-DS, combining the physiological advantages of pylorus preservation and the technical benefits of single-loop reconstruction, associating a sleeve gastrectomy and a duodeno-ileal bypass at 2.5 meters from the ileo-caecal valve if BMI ≥ 50 kg/m² or at 3 meters if BMI \< 50

RYGB

This corresponds to obese patients (BMI ≥40 kg/m2 or BMI ≥35 kg/m2 +/- co-morbidities (high blood pressure, dyslipidemia, obstructive sleep apnea, type 2 diabetes mellitus, arthrosis)) benefiting from a laparoscopic RYGB (laparoscopic Roux-en-Y Gastric ByPass).

Similarly to the experimental group, RYGB will be performed as a primary procedure or after failure of sleeve gastrectomy, which is defined as insufficient weight loss at 18 months after surgery (EWL% \<50), or as weight regain (+ 20% of nadir weight).

Group Type ACTIVE_COMPARATOR

RYGB

Intervention Type PROCEDURE

The laparoscopic Roux-en-Y Gastric Bypass will consist of:

* a small gastric pouch (about 30cc)
* an antecolic alimentary limb
* a gastro-jejunal anastomosis using a linear stapler
* a 150cm long alimentary limb
* a 50cm biliary limb
* a latero-lateral jejuno-jejunal anastomosis
* closure of the mesenteric defects

Interventions

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SADI-S

Laparoscopic SADI-S, recently described as an evolution of the BPD-DS, combining the physiological advantages of pylorus preservation and the technical benefits of single-loop reconstruction, associating a sleeve gastrectomy and a duodeno-ileal bypass at 2.5 meters from the ileo-caecal valve if BMI ≥ 50 kg/m² or at 3 meters if BMI \< 50

Intervention Type PROCEDURE

RYGB

The laparoscopic Roux-en-Y Gastric Bypass will consist of:

* a small gastric pouch (about 30cc)
* an antecolic alimentary limb
* a gastro-jejunal anastomosis using a linear stapler
* a 150cm long alimentary limb
* a 50cm biliary limb
* a latero-lateral jejuno-jejunal anastomosis
* closure of the mesenteric defects

Intervention Type PROCEDURE

Other Intervention Names

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Laparoscopic Single-anastomosis duodeno ileal bypass with Sleeve gastrectomy (SADI-S) Roux-en-Y Gastric ByPass

Eligibility Criteria

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Inclusion Criteria

* Patient aged between 18 and 65 years old,
* Morbid obesity with BMI ≥40 kg/m2 or BMI ≥35 kg/m2 associated with one co-morbidity which will be improved by surgery (high blood pressure, type 2 diabetes mellitus, obstructive sleep apnea, dyslipidemia, arthrosis)
* Patient who has benefited from an upper GI endoscopy with biopsies to look for Helicobacter pylori , within the 12 months before surgery,
* Patient who has benefited from a pluridisciplinary evaluation, with a favorable opinion for SADI-S or RYGB as a primary surgery or after failure of sleeve gastrectomy (defined as insufficient weight loss at 18 months after surgery (EWL% \<50), or as weight regain (+ 20%)).
* Patient who understands and accepts the need for a long term follow-up,
* Patient who agrees to be included in the study and who signs the informed consent form,
* Patient affiliated with a healthcare insurance plan.

Exclusion Criteria

* History of previous bariatric surgery, other than a sleeve gastrectomy,
* Presence of a severe and evolutive life threatening pathology, unrelated to obesity,
* History of type 1 diabete,
* History of chronic inflammatory bowel disease,
* Pregnancy or desire to be pregnant during the study,
* Presence of Helicobacter pylori resistant to medical treatment,
* Presence of a unhealed gastro-duodenal ulcer or diagnosed less than 2 months previously,
* Mentally unbalanced patients, under supervision or guardianship,
* Patient who does not understand French/ is unable to give consent,
* Patient not affiliated to a French or European healthcare insurance,
* Patient who has already been included in a trial which has a conflict of interests with the present study
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Hospices Civils de Lyon

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Département de Chirurgie Digestive et Viscérale - Clinique de l'Anjou

Angers, , France

Site Status

Service de Chirurgie Digestive et Endocrinienne - Groupe Hospitalier Pellegrin

Bordeaux, , France

Site Status

Service de Chirurgie Digestive et Viscérale - Clinique La Parisière

Bourg-de-Péage, , France

Site Status

Département de Chirurgie Digestive et Viscérale, Centre Hospitalier Jean Marcel

Brignoles, , France

Site Status

Département de Chirurgie Digestive, Centre Hospitalier René Dubos

Cergy-Pontoise, , France

Site Status

Département de Chirurgie Digestive et Thoracique, Hôpitaux Civils de Colmar

Colmar, , France

Site Status

Service de Chirurgie Générale et Digestive - Hôpital Louis Mourier

Colombes, , France

Site Status

Service de Chirurgie Digestive - Centre Hospitalier Intercommunal de Créteil

Créteil, , France

Site Status

Département de Chirurgie Digestive - CHU Grenoble

Grenoble, , France

Site Status

Service de Chirurgie Générale et Endocrinienne - Hôpital Huriez

Lille, , France

Site Status

Service de Chirurgie Digestive et Bariatrique - Hôpital Edouard Herriot - HCL

Lyon, , France

Site Status

Service de Chirurgie Digestive et Endocrinienne - Hôtel Dieu

Nantes, , France

Site Status

Service de Chirurgie Digestive et Transplantation - Hôpital Archet II

Nice, , France

Site Status

Département de Chirurgie Digestive et Hépatobiliaire - Hôpital Pitié Salpétrière

Paris, , France

Site Status

Département de Chirurgie Digestive - Institut Mutualiste Montsouris

Paris, , France

Site Status

Service de Chirurgie Digestive - Hôpital Bichat

Paris, , France

Site Status

Service de Chirurgie Digestive, Générale et Cancérologique - HEGP

Paris, , France

Site Status

Service d'Endocrinologie, Diabète et Nutrition - Centre Hospitalier Lyon Sud - HCL

Pierre-Bénite, , France

Site Status

Département de Chirurgie Digestive et Hépatobiliaire - Centre Hospitalier Privé Saint Grégoire

Saint-Grégoire, , France

Site Status

Département de Chirurgie Digestive et Bariatrique, Clinique Mutualiste de l'Estuaire

Saint-Nazaire, , France

Site Status

Service de Chirurgie Digestive, Hôpital Rangueil

Toulouse, , France

Site Status

Service de Chirurgie Digestive, Hépatobiliaire et Endocrinienne - Hôpital Brabois adultes

Vandœuvre-lès-Nancy, , France

Site Status

Countries

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France

References

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Robert M, Poghosyan T, Delaunay D, Pelascini E, Iceta S, Sterkers A, Barsamian C, Khamphommala L, Bin Dorel S, Maucort-Boulch D, Czernichow S, Disse E. Prospective multicentre randomised trial comparing the efficacy and safety of single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) versus Roux-en-Y gastric bypass (RYGB): SADISLEEVE study protocol. BMJ Open. 2020 Sep 1;10(9):e037576. doi: 10.1136/bmjopen-2020-037576.

Reference Type BACKGROUND
PMID: 32873678 (View on PubMed)

Robert M, Poghosyan T, Romain-Scelle N, Czernichow S, Delaunay D, Sterkers A, Khamphommala L, Lazzati A, Blanchard C, Caiazzo R, Pattou F, Disse E; SADISLEEVE Collaborative Group. Efficacy and safety of single-anastomosis duodeno-ileal bypass with sleeve gastrectomy versus Roux-en-Y gastric bypass in France (SADISLEEVE): results of a randomised, open-label, superiority trial at 2 years of follow-up. Lancet. 2025 Aug 23;406(10505):846-859. doi: 10.1016/S0140-6736(25)01070-0.

Reference Type RESULT
PMID: 40849141 (View on PubMed)

Osorio J, Lazzara C, Guimaraes M, Torres A, Turrado-Rodriguez V, Ibarzabal A, Sobrino L, Nora M, Vilarrassa N, de Hollanda A, Rubio-Herrera MA, Vidal J, Moize V, Yarnoz C, Fernandez-Falop I, Portillo M, Sanchez-Pernaute A. A randomized open-label multicentre clinical trial comparing single-anastomosis duodenal switch (SADI-S) versus Roux-en-Y gastric bypass for the treatment of severe obesity: BYPSADIS study protocol. Scand J Surg. 2025 Oct 17:14574969251385873. doi: 10.1177/14574969251385873. Online ahead of print.

Reference Type DERIVED
PMID: 41104829 (View on PubMed)

Other Identifiers

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2018-A01051-54

Identifier Type: OTHER

Identifier Source: secondary_id

69HCL18_0042

Identifier Type: -

Identifier Source: org_study_id

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