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Gastric bypass may be particularly suitable for patients who: Have poorly controlled type 2 diabetes, given its superior glycaemic outcomes Suffer from significant acid reflux, GORD, or Barrett's oesophagus Have a very high BMI and require maximum weight loss Have previously undergone sleeve gastrectomy with insufficient weight loss (bypass can be performed as a revision procedure) Sleeve gastrectomy may be preferable for patients who: Have a lower surgical risk profile and prefer a simpler procedure Wish to avoid the malabsorptive component and associated nutritional monitoring burden Have inflammatory bowel disease or conditions affecting the small intestine (though this should be assessed on a case-by-case basis with gastroenterology and MDT input) Are considering future pregnancy, as nutritional management may be more straightforward though conception should be avoided for at least 1218 months post-operatively regardless of procedure In patients with very high BMI, other procedures (such as SADI-S or duodenal switch) may be considered by the MDT, though these are beyond the scope of this comparison

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