Metabolic and Hormonal Changes After Laparoscopic Roux-en-Y Gastric Bypass and Sleeve Gastrectomy: a Randomized, Prospective Trial
Ralph Peterli,Robert E. Steinert,Bettina Woelnerhanssen,Thomas Peters,Caroline Christoffel-Courtin,Markus Gass,Beatrice Kern,Markus von Fluee,Christoph Beglinger +8 more
TL;DR: Bypassing the foregut is not the only mechanism responsible for improved glucose homeostasis, as body weight and BMI decreased markedly and comparably leading to an identical improvement of abnormal glycemic control (HOMA index) in both groups.
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Abstract: The mechanisms of amelioration of glycemic control early after laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) are not fully understood. In this prospective, randomized 1-year trial, outcomes of LRYGB and LSG patients were compared, focusing on possibly responsible mechanisms. Twelve patients were randomized to LRYGB and 11 to LSG. These non-diabetic patients were investigated before and 1 week, 3 months, and 12 months after surgery. A standard test meal was given after an overnight fast, and blood samples were collected before, during, and after food intake for hormone profiles (cholecystokinin (CCK), ghrelin, glucagon-like peptide 1 (GLP-1), peptide YY (PYY)). In both groups, body weight and BMI decreased markedly and comparably leading to an identical improvement of abnormal glycemic control (HOMA index). Post-surgery, patients had markedly increased postprandial plasma GLP-1 and PYY levels (p < 0.05) with ensuing improvement in glucose homeostasis. At 12 months, LRYGB ghrelin levels approached preoperative values. The postprandial, physiologic fluctuation returned, however, while LSG ghrelin levels were still markedly attenuated. One year postoperatively, CCK concentrations after test meals increased less in the LRYGB group than they did in the LSG group, with the latter showing significantly higher maximal CCK concentrations (p < 0.012 vs. LRYGB). Bypassing the foregut is not the only mechanism responsible for improved glucose homeostasis. The balance between foregut (ghrelin, CCK) and hindgut (GLP-1, PYY) hormones is a key to understanding the underlying mechanisms.
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Citations
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TL;DR: The Swiss Multicenter Bypass or Sleeve Study (SM-BOSS), a 2-group randomized trial, was conducted from January 2007 until November 2011 (last follow-up in March 2017) as mentioned in this paper.
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Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss in Patients With Morbid Obesity
Ralph Peterli,Bettina K. Wölnerhanssen,Thomas Peters,Diana Vetter,Dino Kröll,Yves Michael Borbély,Bernd Schultes,Christoph Beglinger,Jürgen Drewe,Marc Schiesser,Philipp C. Nett,Marco Bueter +11 more
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References
The Mechanism of Diabetes Control After Gastrointestinal Bypass Surgery Reveals a Role of the Proximal Small Intestine in the Pathophysiology of Type 2 Diabetes
Francesco Rubino,Antonello Forgione,David E. Cummings,Michel Vix,Donatella Gnuli,Geltrude Mingrone,Marco Castagneto,Jacques Marescaux +7 more
TL;DR: This study shows that bypassing a short segment of proximal intestine directly ameliorates type 2 diabetes, independently of effects on food intake, body weight, malabsorption, or nutrient delivery to the hindgut.
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Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study
TL;DR: The markedly reduced ghrelin levels in addition to increased PYY levels after LSG, are associated with greater appetite suppression and excess weight loss compared with LRYGBP.
The Early Effect of the Roux-en-Y Gastric Bypass on Hormones Involved in Body Weight Regulation and Glucose Metabolism
Francesco Rubino,Michel Gagner,Paolo Gentileschi,Subhash Kini,S. Fukuyama,John J. Feng,Ed J. Diamond +6 more
TL;DR: Roux-en-Y gastric bypass determines considerable hormonal changes before significant BMI changes take place, and results support the hypothesis of an endocrine effect as the possible mechanism of action of RYGB.
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Improvement in glucose metabolism after bariatric surgery : comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy : a prospective randomized trial
Ralph Peterli,Bettina K. Wölnerhanssen,Thomas Peters,Noémie Devaux,Beatrice Kern,Caroline Christoffel-Courtin,Juergen Drewe,Markus von Flüe,Christoph Beglinger +8 more
TL;DR: Both procedures markedly improved glucose homeostasis: insulin, GLP-1, and PYY levels increased similarly after either procedure, and the results do not support the idea that the proximal small intestine mediates the improvement in glucoseHomeostasis.
589
Diabetes and hypertension in severe obesity and effects of gastric bypass-induced weight loss.
TL;DR: GBP-induced weight loss is effective in correcting diabetes, hypertension, and other comorbidities but is related to the %EWL achieved, suggesting that GBP surgery for severe obesity should be provided earlier to patients to prevent the development of diabetes and hypertension and their complications.
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