{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T02:56:05Z","timestamp":1770173765221,"version":"3.49.0"},"reference-count":132,"publisher":"National Institute for Health and Care Research","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000664","name":"Health Technology Assessment programme","doi-asserted-by":"publisher","award":["09\/127\/53"],"award-info":[{"award-number":["09\/127\/53"]}],"id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journalslibrary.nihr.ac.uk"],"crossmark-restriction":false},"short-container-title":["Health Technol Assess"],"abstract":"<jats:sec id=\"abs1-1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Bariatric surgery can improve health outcomes but high-quality comparative evidence about different procedures is limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-2\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare the effectiveness and cost-effectiveness of Roux-en-Y gastric bypass (Bypass), adjustable gastric banding (Band) and sleeve gastrectomy (Sleeve) for people living with severe obesity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-3\">\n                    <jats:title>Design, setting and participants<\/jats:title>\n                    <jats:p>\n                      Multicentre, parallel-group, randomised controlled trial conducted in 12 National Health Service hospitals. Adults with a body mass index \u2265\u200535\u2005kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      with comorbidity or body mass index \u2265\u200540\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      without comorbidity were eligible. Participants were initially randomised 1\u2005:\u20051 to Bypass or Band. After 32 months of recruitment, the trial was adapted to include Sleeve, and participants were randomised to Bypass, Band or Sleeve thereafter. Participants were followed up for 3 years.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-4\">\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Bypass, Band and Sleeve surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-5\">\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>Primary outcomes were self-reported quality of life (EQ-5D-5L utility score) and weight (at least 50% excess weight lost) at 3 years. Sleeve and Bypass were each considered superior to Band if there was non-inferior excess weight loss (&lt;\u200512% difference between groups) and superior quality of life. Sleeve was considered superior to Bypass by the same criteria. Secondary outcomes included comorbidities, adverse health events, generic and disease-specific quality of life at 6, 12, 24 and 36 months post randomisation, dietary intake, binge eating behaviour and cost-effectiveness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-6\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      One thousand three hundred and fifty-one participants were randomised between December 2012 and September 2019. Five participants withdrew consent to use their data, leaving 1346 (462 Bypass, 464 Band, 420 Sleeve). The mean age was 47.3 years, 1020 (75.9%) were women and the mean weight and body mass index was 129.7\u2009kg and 46.4\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      , respectively. Overall, 1183 (87.5%) of participants underwent surgery within 3 years, with a median waiting time of 5 months (interquartile range 2.5\u201310.1 months).\n                    <\/jats:p>\n                    <jats:p>At least 50% excess weight loss at 3 years was achieved for 276\/405 (68.1%) participants randomised to Bypass, 97\/383 (25.3%) randomised to Band and 142\/342 (41.5%) randomised to Sleeve [adjusted risk difference (Bypass\u2013Band) +\u200540.7%, 98% confidence interval (+\u200533.9% to +\u200547.5%); (Sleeve\u2013Band) +\u200514.7% (+\u20055.2% to +\u200524.2%), (Sleeve\u2013Bypass) \u221226.0% (\u221235.8% to \u221216.3%)]. Mean EQ-5D scores at 3 years were 0.72 (standard deviation 0.29), 0.62 (0.33) and 0.68 (0.30) for participants randomised to Bypass, Band and Sleeve, respectively [adjusted mean difference (Bypass\u2013Band) +\u20050.079 (+\u20050.040 to +\u20050.117), (Sleeve\u2013Band) +\u20050.045 (+\u20050.006 to +\u20050.085), (Sleeve\u2013Bypass) \u22120.033 (\u22120.072 to +\u20050.006)]. Secondary outcomes showed similar trends. The adverse event rate was highest in the Band group and lowest with Sleeve. Bypass was the most cost-effective procedure, with probabilities &lt;\u20050.3 that Sleeve or Band was the most cost-effective.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-7\">\n                    <jats:title>Limitations<\/jats:title>\n                    <jats:p>The study was impacted by the COVID-19 pandemic which prevented some participants having surgery and\/or attending hospital for study follow-up appointments, which impacted on the completeness of data for these visits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-8\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Bypass and Sleeve are more effective than Band. Sleeve has inferior excess weight loss and lower mean quality-of-life score than Bypass.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-9\">\n                    <jats:title>Future work<\/jats:title>\n                    <jats:p>Longer-term follow-up is needed to determine the sustainability of observed effects and to examine adverse events. A comparison of optimal gastric bypass and optimal medical therapy for severe obesity is now needed to inform decision-making and health policy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-10\">\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>This trial is registered as ClinicalTrials.gov: NCT02841527, ISRCTN00786323.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-11\">\n                    <jats:title>Funding<\/jats:title>\n                    <jats:p>\n                      This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 09\/127\/53) and is published in full in\n                      <jats:italic>Health Technology Assessment<\/jats:italic>\n                      ; Vol. 30, No. 6. See the NIHR Funding and Awards website for further award information.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3310\/cxse2951","type":"journal-article","created":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T07:57:36Z","timestamp":1741766256000},"page":"1-224","update-policy":"https:\/\/doi.org\/10.3310\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Roux-en-Y gastric bypass, adjustable gastric banding or sleeve gastrectomy for severe obesity: The By-Band-Sleeve randomised controlled trial"],"prefix":"10.3310","member":"6221","published-online":{"date-parts":[[2026,1]]},"reference":[{"key":"key2026020318404600_ref1-bib1","doi-asserted-by":"crossref","first-page":"e1002187","DOI":"10.1371\/journal.pmed.1002187","article-title":"A core outcome set for the benefits and adverse events of bariatric and metabolic surgery: the BARIACT project","volume":"13","author":"Coulman","year":"2016","journal-title":"PLOS Med"},{"key":"key2026020318404600_ref2-bib2","doi-asserted-by":"crossref","first-page":"1654","DOI":"10.1038\/ijo.2017.153","article-title":"Enabling recruitment success in bariatric surgical trials: pilot phase of the By-Band-Sleeve study","volume":"41","author":"Paramasivan","year":"2017","journal-title":"Int J Obes (Lond)"},{"key":"key2026020318404600_ref3-bib3","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1002\/bjs.10562","article-title":"Adaptation of the By-Band randomized clinical trial to By-Band-Sleeve to include a new intervention and maintain relevance of the study to practice","volume":"104","author":"Rogers","year":"2017","journal-title":"Br J Surg"},{"key":"key2026020318404600_ref4-bib4","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1186\/1745-6215-15-53","article-title":"The By-Band study: gastric bypass or adjustable gastric band surgery to treat morbid obesity: study protocol for a multi-centre randomised controlled trial with an internal pilot phase","volume":"15","author":"Rogers","year":"2014","journal-title":"Trials"},{"key":"key2026020318404600_ref5-bib5","doi-asserted-by":"crossref","first-page":"1290","DOI":"10.1002\/oby.23746","article-title":"Roux-en-Y gastric bypass, gastric banding, or sleeve gastrectomy for severe obesity: baseline data from the By-Band-Sleeve randomized controlled trial","volume":"31","author":"By-Band-Sleeve Collaborative Group","year":"2023","journal-title":"Obesity (Silver Spring)"},{"key":"key2026020318404600_ref6-bib6","volume-title":"5th IFSO Global Registry Report","author":"Ramos","year":"2019"},{"key":"key2026020318404600_ref7-bib7","volume-title":"Obesity and Overweight","author":"World Health Organization","year":"2021"},{"key":"key2026020318404600_ref8-bib8","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1016\/S2213-8587(18)30288-2","article-title":"Association of BMI with overall and cause-specific mortality: a population-based cohort study of 3.6 million adults in the UK","volume":"6","author":"Bhaskaran","year":"2018","journal-title":"Lancet Diabetes Endocrinol"},{"key":"key2026020318404600_ref9-bib9","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1016\/j.amjmed.2008.05.036","article-title":"Gastric banding or bypass? 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