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Diabetes Remission After LRYGBP With and Without Fundus Resection: a Randomized Clinical Trial

BACKGROUND: Glycemic control, after metabolic surgery, is achieved in two stages, initially with neuroendocrine alterations and in the long-term with sustainable weight loss. The resection of the gastric fundus, as the major site of ghrelin production, is probably related with optimized glucose regu...

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Autores principales: Kehagias, Dimitrios, Lampropoulos, Charalampos, Georgopoulos, Neoklis, Habeos, Ioannis, Kalavrizioti, Dimitra, Vamvakas, Sotirios-Spyridon, Davoulou, Panagiota, Kehagias, Ioannis
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10602944/
https://www.ncbi.nlm.nih.gov/pubmed/37783932
http://dx.doi.org/10.1007/s11695-023-06857-z
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author Kehagias, Dimitrios
Lampropoulos, Charalampos
Georgopoulos, Neoklis
Habeos, Ioannis
Kalavrizioti, Dimitra
Vamvakas, Sotirios-Spyridon
Davoulou, Panagiota
Kehagias, Ioannis
author_facet Kehagias, Dimitrios
Lampropoulos, Charalampos
Georgopoulos, Neoklis
Habeos, Ioannis
Kalavrizioti, Dimitra
Vamvakas, Sotirios-Spyridon
Davoulou, Panagiota
Kehagias, Ioannis
author_sort Kehagias, Dimitrios
collection PubMed
description BACKGROUND: Glycemic control, after metabolic surgery, is achieved in two stages, initially with neuroendocrine alterations and in the long-term with sustainable weight loss. The resection of the gastric fundus, as the major site of ghrelin production, is probably related with optimized glucose regulation. The aim of the present study is to investigate whether the modification of laparoscopic Roux-en-Y gastric bypass (LRYGBP) with fundus resection offers superior glycemic control, compared to typical LRYGBP. MATERIALS AND METHODS: Participants were 24 patients with body mass index (BMI) ≥40kg/m(2) and type II diabetes mellitus (T2DM), who were randomly assigned to undergo LRYGBP and LRYGBP with fundus resection (LRYGBP+FR). Gastrointestinal (GI) hormones [ghrelin, glucagon-like-peptide-1 (GLP-1), peptide-YY (PYY)] and glycemic parameters (glucose, insulin, HbA1c, C-peptide, insulinogenic index, HOMA-IR) were measured preoperatively, at 6 and 12 months during an oral glucose tolerance test (OGTT). RESULTS: Ninety-five percent of patients showed complete remission of T2DM after 12 months. LRYGBP+FR was not related with improved glycemic control, compared to LRYGBP. Ghrelin levels were not significantly reduced at 6 and 12 months after LRYGBP+FR. GLP-1 and PYY levels were remarkably increased postprandially in both groups at 6 and 12 months postoperatively (p<0.01). Patients who underwent LRYGBP+FR achieved a significantly lower BMI at 12 months in comparison to LRYGBP (p<0.05). CONCLUSION: Fundus resection is not associated with improved glycemic regulation, compared to typical LRYGBP and the significant decrease in BMI after LRYGBP+FR has to be further confirmed with longer follow-up. GRAPHICAL ABSTRACT: [Image: see text]
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spelling pubmed-106029442023-10-28 Diabetes Remission After LRYGBP With and Without Fundus Resection: a Randomized Clinical Trial Kehagias, Dimitrios Lampropoulos, Charalampos Georgopoulos, Neoklis Habeos, Ioannis Kalavrizioti, Dimitra Vamvakas, Sotirios-Spyridon Davoulou, Panagiota Kehagias, Ioannis Obes Surg Original Contributions BACKGROUND: Glycemic control, after metabolic surgery, is achieved in two stages, initially with neuroendocrine alterations and in the long-term with sustainable weight loss. The resection of the gastric fundus, as the major site of ghrelin production, is probably related with optimized glucose regulation. The aim of the present study is to investigate whether the modification of laparoscopic Roux-en-Y gastric bypass (LRYGBP) with fundus resection offers superior glycemic control, compared to typical LRYGBP. MATERIALS AND METHODS: Participants were 24 patients with body mass index (BMI) ≥40kg/m(2) and type II diabetes mellitus (T2DM), who were randomly assigned to undergo LRYGBP and LRYGBP with fundus resection (LRYGBP+FR). Gastrointestinal (GI) hormones [ghrelin, glucagon-like-peptide-1 (GLP-1), peptide-YY (PYY)] and glycemic parameters (glucose, insulin, HbA1c, C-peptide, insulinogenic index, HOMA-IR) were measured preoperatively, at 6 and 12 months during an oral glucose tolerance test (OGTT). RESULTS: Ninety-five percent of patients showed complete remission of T2DM after 12 months. LRYGBP+FR was not related with improved glycemic control, compared to LRYGBP. Ghrelin levels were not significantly reduced at 6 and 12 months after LRYGBP+FR. GLP-1 and PYY levels were remarkably increased postprandially in both groups at 6 and 12 months postoperatively (p<0.01). Patients who underwent LRYGBP+FR achieved a significantly lower BMI at 12 months in comparison to LRYGBP (p<0.05). CONCLUSION: Fundus resection is not associated with improved glycemic regulation, compared to typical LRYGBP and the significant decrease in BMI after LRYGBP+FR has to be further confirmed with longer follow-up. GRAPHICAL ABSTRACT: [Image: see text] Springer US 2023-10-02 2023 /pmc/articles/PMC10602944/ /pubmed/37783932 http://dx.doi.org/10.1007/s11695-023-06857-z Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Contributions
Kehagias, Dimitrios
Lampropoulos, Charalampos
Georgopoulos, Neoklis
Habeos, Ioannis
Kalavrizioti, Dimitra
Vamvakas, Sotirios-Spyridon
Davoulou, Panagiota
Kehagias, Ioannis
Diabetes Remission After LRYGBP With and Without Fundus Resection: a Randomized Clinical Trial
title Diabetes Remission After LRYGBP With and Without Fundus Resection: a Randomized Clinical Trial
title_full Diabetes Remission After LRYGBP With and Without Fundus Resection: a Randomized Clinical Trial
title_fullStr Diabetes Remission After LRYGBP With and Without Fundus Resection: a Randomized Clinical Trial
title_full_unstemmed Diabetes Remission After LRYGBP With and Without Fundus Resection: a Randomized Clinical Trial
title_short Diabetes Remission After LRYGBP With and Without Fundus Resection: a Randomized Clinical Trial
title_sort diabetes remission after lrygbp with and without fundus resection: a randomized clinical trial
topic Original Contributions
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10602944/
https://www.ncbi.nlm.nih.gov/pubmed/37783932
http://dx.doi.org/10.1007/s11695-023-06857-z
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