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Kehagias D, Lampropoulos C, Georgopoulos N, Habeos I, Kalavrizioti D, Vamvakas SS, Davoulou P, Kehagias I. Diabetes Remission After LRYGBP With and Without Fundus Resection: a Randomized Clinical Trial. Obes Surg 2023; 33:3373-3382. [PMID: 37783932 PMCID: PMC10602944 DOI: 10.1007/s11695-023-06857-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 09/13/2023] [Accepted: 09/24/2023] [Indexed: 10/04/2023]
Abstract
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/m2 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.
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Affiliation(s)
| | | | - Neoklis Georgopoulos
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Patras Medical School, 26504, Rio, Greece
| | - Ioannis Habeos
- Department of Internal Medicine, Division of Endocrinology and Diabetes, University Hospital of Patras, 26504, Rio, Greece
| | - Dimitra Kalavrizioti
- Department of Nephrology and Renal Transplantation, University Hospital of Patras, 26504, Rio, Greece
| | | | - Panagiota Davoulou
- Department of Nephrology and Renal Transplantation, University Hospital of Patras, 26504, Rio, Greece
| | - Ioannis Kehagias
- Department of Surgery, Division of Bariatric and Metabolic Surgery, University Hospital of Patras, 26504, Rio, Greece
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Zhu C, Wen X, You H, Lu L, Du L, Qian C. Improved Insulin Secretion Response and Beta-cell Function Correlated with Increased Prolactin Levels After Laparoscopic Sleeve Gastrectomy in Morbidly Obese Patients with Acanthosis Nigricans. Obes Surg 2023; 33:2405-2419. [PMID: 37338797 DOI: 10.1007/s11695-023-06686-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/04/2023] [Accepted: 06/08/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVE To explore insulin secretion patterns, β-cell function, and serum prolactin (PRL) concentrations in Chinese morbidly obese patients with Acanthosis nigricans (AN) and their alterations after laparoscopic sleeve gastrectomy (LSG). METHODS A total of 138 morbidly obese subjects undergoing LSG were categorized as simple obesity without AN (OB group, n = 55) and obesity with AN (AN group, n = 83). Oral glucose tolerance test (OGTT), PRL, and related metabolic indices were performed pre- and 12 months post-LSG. Insulin secretion patterns were derived from insulin secretion peak time during OGTT: type I (peak at 30 or 60 min) and type II (peak at 120 or 180 min). RESULTS Preoperatively, AN group showed significantly higher proportions of type II insulin secretion pattern, fasting insulin (FINS), and homeostatic model assessment of insulin resistance (HOMA-IR) whereas lower oral glucose insulin sensitivity (OGIS), insulinogenic index (IGI), and disposition index (DI) than OB group, which were improved significantly at 12 months postoperatively in both groups, more pronounced in AN group. Intriguingly, serum PRL declined substantially in AN group than OB group at baseline whereas elevated only in the AN group post-LSG. After adjusting for confounding factors, elevated PRL correlated significantly with increased IGI and DI, and decreased HOMA-IR in both genders, as well as increased OGIS in females, which was detected only in the AN group CONCLUSION: Morbidly obese patients with AN presented delayed insulin secretion response, impaired insulin secretion, and β-cell dysfunction, which were significantly improved by LSG and might benefit from elevated PRL.
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Affiliation(s)
- Cuiling Zhu
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Middle Yanchang Road, Shanghai, 200072, China
| | - Xin Wen
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Middle Yanchang Road, Shanghai, 200072, China
| | - Hui You
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Middle Yanchang Road, Shanghai, 200072, China
| | - Liesheng Lu
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Middle Yanchang Road, Shanghai, 200072, China
| | - Lei Du
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Middle Yanchang Road, Shanghai, 200072, China
| | - Chunhua Qian
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Middle Yanchang Road, Shanghai, 200072, China.
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3
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Kehagias D, Georgopoulos N, Habeos I, Lampropoulos C, Mulita F, Kehagias I. The role of the gastric fundus in glycemic control. Hormones (Athens) 2023; 22:151-163. [PMID: 36705877 DOI: 10.1007/s42000-023-00429-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/10/2023] [Indexed: 01/28/2023]
Abstract
PURPOSE Ghrelin, one of the most studied gut hormones, is mainly produced by the gastric fundus. Abundant evidence exists from preclinical and clinical studies underlining its contribution to glucose regulation. In the following narrative review, the role of the gastric fundus in glucose regulation is summarized and we investigate whether its resection enhances glycemic control. METHODS An electronic search was conducted in the PubMed® database and in Google Scholar® using a combination of medical subject headings (MeSH). We examined types of metabolic surgery, including, in particular, gastric fundus resection, either as part of laparoscopic sleeve gastrectomy (LSG) or modified laparoscopic gastric bypass with fundus resection (LRYGBP + FR), and the contribution of ghrelin reduction to glucose regulation. RESULTS Fourteen human studies were judged to be eligible and included in this narrative review. Reduction of ghrelin levels after fundus resection might be related to early glycemic improvement before significant weight loss is achieved. Long-term data regarding the role of ghrelin reduction in glucose homeostasis are sparse. CONCLUSION The exact role of ghrelin in achieving glycemic control is still ambiguous. Data from human studies reveal a potential contribution of ghrelin reduction to early glycemic improvement, although further well-designed studies are needed.
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Affiliation(s)
- Dimitrios Kehagias
- Department of General Surgery, General University Hospital of Patras, 26504, Rio, Greece.
| | - Neoklis Georgopoulos
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, University of Patras Medical School, 26504, Rio, Greece
| | - Ioannis Habeos
- Division of Endocrinology and Diabetes, Department of Internal Medicine, University Hospital of Patras, 26504, Rio, Greece
| | | | - Francesk Mulita
- Department of General Surgery, General University Hospital of Patras, 26504, Rio, Greece
| | - Ioannis Kehagias
- Division of Bariatric and Metabolic Surgery, Department of Surgery, General University Hospital of Patras, 26504, Rio, Greece
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Glucose variability and predicted cardiovascular risk after gastrectomy. Surg Today 2022; 52:1634-1644. [PMID: 35357573 DOI: 10.1007/s00595-022-02496-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/27/2022] [Indexed: 01/19/2023]
Abstract
PURPOSE To investigate the correlation between glycemic trends and cardiovascular risk after gastrectomy for gastric cancer. METHODS We enrolled 105 gastric cancer patients who underwent gastrectomy at our hospital between October 2017 and July 2020. Postoperative glucose concentrations, trends, and patterns were recorded using a continuous glucose monitoring (CGM) device. Cardiovascular risk was calculated using the Framingham stroke risk profile score (FSRPS), the Framingham risk score (FRS), and the Suita score. We examined the correlations between glycemic variability and cardiovascular risk scores. RESULTS There were significant differences in the standard deviation (SD) of glucose levels between the high and low FSRPS groups (p = 0.049), the high and low FRS groups (p = 0.011), and the high and low Suita score groups (p = 0.044). The SD of glucose levels was significantly higher in patients with diabetes mellitus (DM) (p < 0.001) and those who underwent total gastrectomy (TG) (p = 0.017). Additionally, the CGM data available for 38 patients 1 year post-gastrectomy were analyzed for glucose level dynamics, and the SD was found to be significantly higher than that at 1 month (p < 0.001). CONCLUSION Our findings suggest that long-term follow-up and therapeutic strategies tailored to glycemic trends may be necessary for gastric cancer patients after gastrectomy, especially those with DM and those who have undergone TG, to prevent cardiovascular events.
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Protective and Healing Effects of Ghrelin and Risk of Cancer in the Digestive System. Int J Mol Sci 2021; 22:ijms221910571. [PMID: 34638910 PMCID: PMC8509076 DOI: 10.3390/ijms221910571] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 01/19/2023] Open
Abstract
Ghrelin is an endogenous ligand for the ghrelin receptor, previously known as the growth hormone secretagogue receptor. This hormone is mainly produced by endocrine cells present in the gastric mucosa. The ghrelin-producing cells are also present in other organs of the body, mainly in the digestive system, but in much smaller amount. Ghrelin exhibits a broad spectrum of physiological effects, such as stimulation of growth hormone secretion, gastric secretion, gastrointestinal motility, and food intake, as well as regulation of glucose homeostasis and bone formation, and inhibition of inflammatory processes. This review summarizes the recent findings concerning animal and human data showing protective and therapeutic effects of ghrelin in the gut, and also presents the role of growth hormone and insulin-like growth factor-1 in these effects. In addition, the current data on the possible influence of ghrelin on the carcinogenesis, its importance in predicting the risk of developing gastrointestinal malignances, as well as the potential usefulness of ghrelin in the treatment of cancer, have been presented.
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Bozkurt E, Kaya C, Ömeroğlu S, Güven O, Mihmanlı M. The rapid effects of sleeve gastrectomy on glucose homeostasis and resolution of diabetes mellitus. Endocrinol Diabetes Metab 2021; 4:e00182. [PMID: 33855197 PMCID: PMC8029577 DOI: 10.1002/edm2.182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 08/07/2020] [Indexed: 01/19/2023] Open
Abstract
Aims Type 2 diabetes caused by obesity is increasing globally. Bariatric surgical procedures are known to have positive effects on glucose homeostasis through neurohormonal action mechanisms. In the present study, we aimed to investigate the factors influencing glucose homeostasis independent of weight loss after the laparoscopic sleeve gastrectomy (LSG). Methods Patients who underwent LSG for morbid obesity in a 3-year period were evaluated. Data on demographics, clinical characteristics (duration of diabetes, resected gastric volume, antral resection margin) and laboratory parameters (preoperative and postoperative blood glucose on fasting, preoperative HbA1c levels and first-year HbA1c levels) were retrospectively reviewed. Effect of patients' body mass index (<50 kg/m2, ≥50 kg/m2), first-year excess weight loss (EWL%) rates, age (≥50 years, <50 years), duration of diabetes (≥5 years, <5 years) and antral resection margin (≥3 cm, <3 cm) on postoperative blood glucose profile and diabetic resolution status were investigated. Results Total of 61 patients constituted the study group. There were 40 female and 21 male patients with an average age of 43.8 ± 10.5 years (19-67 years). Preoperatively, mean BMI, blood glucose levels and HbA1c were 48.8 ± 8.5 kg/m2, 133.6 ± 47.4 mg/dL and 7.4 ± 1.1, respectively. The mean blood glucose level at the postoperatively 5th day was 88.0 ± 16.3 mg/dL (median: 84 mg/dL) (P < .001). Fifty-nine out of 61 patients improved their glycaemic control. Conclusions It is noteworthy that LSG can control blood glucose levels in short term after surgery regardless of weight loss. Therefore, LSG should be preferred at earlier stages in the treatment of obesity-related T2DM in order to prevent T2DM-related complications.
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Affiliation(s)
- Emre Bozkurt
- Deparment of General SurgeryUniversity of Health Sciences Sisli Hamidiye Etfal Education and Research HospitalİstanbulTurkey
| | - Cemal Kaya
- Deparment of General SurgeryUniversity of Health Sciences Sisli Hamidiye Etfal Education and Research HospitalİstanbulTurkey
| | - Sinan Ömeroğlu
- Deparment of General SurgeryUniversity of Health Sciences Sisli Hamidiye Etfal Education and Research HospitalİstanbulTurkey
- Present address:
Department of Gastrointestinal SurgeryUniversity of Health Sciences Kartal Koşuyolu High Speciality Educational and Research HospitalIstanbulTurkey
| | - Onur Güven
- Deparment of General SurgeryUniversity of Health Sciences Sisli Hamidiye Etfal Education and Research HospitalİstanbulTurkey
| | - Mehmet Mihmanlı
- Deparment of General SurgeryUniversity of Health Sciences Sisli Hamidiye Etfal Education and Research HospitalİstanbulTurkey
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Geometry of Sleeve Gastrectomy Measured by 3D CT Versus Weight Loss: Preliminary Analysis. World J Surg 2020; 45:235-242. [PMID: 33037439 DOI: 10.1007/s00268-020-05807-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND The size of the remnant stomach with respect to weight loss failure after laparoscopic sleeve gastrectomy (LSG) remains controversial. This study aimed to evaluate the impact of the actual size and volume of the remnant stomach, as measured by three-dimensional computed tomography (3D-CT) volumetry, on weight loss after LSG. METHODS The clinical outcomes of 52 patients who underwent LSG between October 2008 and February 2019 were assessed. Weight metrics were recorded at 1, 3, and 6 months and 1 year postoperatively. 3D-CT volumetry was performed 1 year postoperatively, and the total remnant stomach volume (TSV), proximal stomach volume (PSV), antral stomach volume (ASV), and the distance between the pylorus and the distal edge of staple line (DPS) were measured. The relationship between the weight metrics and aforementioned factors was analyzed. RESULTS Of the 52 patients who underwent LSG, 40 patients participated in this study. The average body mass index preoperatively was 38.3 ± 5.1 kg/m2, and the average percentage of total weight loss (%TWL) 1 year after LSG was 26.6 ± 9.3%. The average TSV, PSV, ASV, and DPS were 123.2 ± 60.3 ml, 73.4 ± 37.2 ml, 49.8 ± 30.3 ml, and 59.9 ± 18.5 mm, respectively. The DPS (r = - 0.394, p = 0.012) and ASV (r = - 0.356, p = 0.024) were correlated with %TWL 1 year postoperatively. CONCLUSIONS The actual DPS and ASV measured by 3D-CT affected weight loss after LSG. 3D-CT may be useful for the immediate identification of factors affecting insufficient weight loss in patients; this may, in turn, aid in the implementation of early intervention treatments.
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ÖNMEZ A, EŞBAH O, ŞAHİN İE. Investigation of serum Seladin-1 / DHCR24 levels in breast cancer patients. KONURALP TIP DERGISI 2020. [DOI: 10.18521/ktd.785524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Impact of 3D-CT-Based Gastric Wall Volume on Weight Loss after Laparoscopic Sleeve Gastrectomy. Obes Surg 2020; 30:4226-4233. [DOI: 10.1007/s11695-020-04783-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Wang L, Wang J, Jiang T. Effect of Laparoscopic Sleeve Gastrectomy on Type 2 Diabetes Mellitus in Patients with Body Mass Index less than 30 kg/m 2. Obes Surg 2020; 29:835-842. [PMID: 30536018 DOI: 10.1007/s11695-018-3602-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) has been proved to be the most effective treatment strategy for the treatment of type 2 diabetes mellitus (T2DM) with a body mass index ≥ 30 kg/m2 achieving high remission rates. However, there are few clinical studies on the treatment of T2DM patients with a body mass index less than 30 kg/m2 by LSG. This study aims to study the effect of LSG on type 2 diabetes mellitus(T2DM) in patients with a body mass index (BMI) less than 30 kg/m2. METHODS The clinical data of 25 patients with type 2 diabetes mellitus (T2DM) and body mass index 23.23-29.97 kg/m2 who were treated by LSG at the Department of Bariatric and Metabolic Surgery in China-Japan Union Hospital of Jilin University from May 2016 to May 2017 were retrospectively analyzed. The changes of fasting plasma glucose, glycosylated hemoglobin, insulin resistance index, body weight, body mass index, waist circumference, blood pressure, heart rate, blood lipids, and uric acid were analyzed at 3 months, 6 months, and 12 months after operation, respectively. All the clinical data were analyzed by SPSS 22.0. They were tested with a single-sample K-S test to determine whether they were normal distribution data. The normal distribution data were analyzed by a matched t test, and the Mann-Whitney test was used to examine skewed data. RESULTS All patients (9 males, 16 females) with a median age of 57(24~65) years were treated successfully by laparoscopic sleeve gastrectomy. The median duration of type 2 diabetes mellitus was 10(0~20)years. The preoperative fasting plasma glucose, glycosylated hemoglobin, body weight, body mass index, and waist circumference were 10.32 ± 2.66 mmol/L,8.20 ± 1.47%,76.54 ± 10.02 kg,27.92 ± 1.72 kg/m2, and 99.88 ± 5.38 cm, respectively. The meaning fasting plasma glucose was 7.26 ± 1.36 mmol/L, 6.90 ± 1.07 mmol/L, and 6.62 ± 0.97 mmol/L, respectively, at 3, 6, and 12 months after operation. The mean HbAlc in the same observation intervals was 6.88 ± 1.23%,6.54 ± 1.02%, and 6.51 ± 0.89%, respectively. The body weight was 62.18 ± 8.38 kg,59.07 ± 8.58 kg, and 58.62 ± 8.53 kg, respectively. The corresponding body mass index was 22.56 ± 1.56 kg/m2, 21.35 ± 1.58 kg/m2, and 21.24 ± 1.86 kg/m2, respectively. The waist circumference was 82.84 ± 5.10 cm,78.60 ± 5.21 cm, and 76.92 ± 5.21 cm, respectively. The complete remission rates of type 2 diabetes mellitus were 40%, 60%, and 68%, respectively, at 3, 6, and 12 months after operation. The complete remission rates for insulin resistance index were 52.4%, 80%, and 80%, postoperatively, at 3, 6, and 12 months, respectively. The complete remission rates of hypertension were 22.2%, 50%, and 75%,respectively, at 3,6, and 12 months after operation. The complete remission rates of hypertriglyceridemia were 66.7%, 66.7%, and 100%,and the complete remission rates of hypercholesterolemia were 41.7%, 60%, and 100%;the abnormal elevations of plasma cholesterol in two patients with normal cholesterol before operation were significantly higher, postoperatively, at 3 monthsand 6 months, respectively. The complete remission rates of hyperuricemia were 37.5%, 33.3%, and 100% in the same observation period, respectively. The abnormal elevations of uric acid in two patients with normal uricemia before operation were significantly higher at postoperative 3 months. CONCLUSION LSG has a significant effect on patients with type 2 diabetes mellitus whose BMI less than 30 kg/m2 in a short time, but its long-term effectiveness needs to be further followed up.
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Affiliation(s)
- Lun Wang
- Department of Bariatric and Metabolic Surgery, China-Japan Union Hospital, Jilin University, Changchun, 130033, China
| | - Jinfa Wang
- Department of Bariatric and Metabolic Surgery, China-Japan Union Hospital, Jilin University, Changchun, 130033, China
| | - Tao Jiang
- Department of Bariatric and Metabolic Surgery, China-Japan Union Hospital, Jilin University, Changchun, 130033, China.
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Gollisch KSC, Raddatz D. Endoscopic intragastric balloon: a gimmick or a viable option for obesity? ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:S8. [PMID: 32309412 PMCID: PMC7154325 DOI: 10.21037/atm.2019.09.67] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Worldwide, the prevalence of obesity has doubled since 1980 in 70 countries. More than one in three adults now suffer from overweight or obesity. Health problems related to obesity include orthopedic problems, psychiatric conditions, metabolic and cardiovascular diseases, and of increasing concern, cancer. Thus, obesity has an enormous impact on the individual’s wellbeing as well as on society’s workforce and health care expenses. Medical efforts are ongoing to find safe and effective treatment options for obesity and its metabolic implications. At present, available treatment options include lifestyle interventions, pharmacotherapy, endoscopic applications, and bariatric surgery. Within the range of endoscopic treatment options, the intragastric balloon is the most widely used device. The idea is simple: the gastric volume is reduced by a balloon that is in most cases implanted by an endoscopic procedure similar to a gastroscopy. During the past decades, different models have been developed, which we will briefly introduce in this review. We aim at reviewing the pathophysiology underlying the effect of endoscopic intragastric balloon on weight loss and metabolic changes. We will assess expected short-term and long-term benefits for the patient, and we will discuss common side effects as well as rare complications. We will compare endoscopic intragastric balloon to conservative treatment options with or without pharmacological support on the one hand and to the spectrum of bariatric surgery on the other hand. In most patients, obesity must be considered a chronic disease that requires a lifelong treatment concept. In view of current treatment options for obesity, we will discuss whether endoscopic intragastric balloon is a viable treatment option, and who may be the right patient to benefit from it.
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Affiliation(s)
- Katja Susanne Claudia Gollisch
- Department of Gastroenterology and Gastrointestinal Oncology, Endocrine Unit, University Medical Center Göttingen, Göttingen, Germany
| | - Dirk Raddatz
- Department of Gastroenterology and Gastrointestinal Oncology, Endocrine Unit, University Medical Center Göttingen, Göttingen, Germany
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Camacho-Ramírez A, Mayo-Ossorio MÁ, Pacheco-García JM, Almorza-Gomar D, Ribelles-García A, Belmonte-Núñez A, Prada-Oliveira JA, Pérez-Arana GM. Pancreas is a preeminent source of ghrelin after sleeve gastrectomy in Wistar rats. Histol Histopathol 2020; 35:801-809. [PMID: 31951010 DOI: 10.14670/hh-18-200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Many surgical techniques are employed in the treatment of severe obesity. A main consequence of these techniques is the improvement of type 2 Diabetes mellitus. Ghrelin is a gut hormone released in the gastric fundus and corpus, which has been related to diabetic improvement as mentioned in these papers. Sleeve gastrectomy and Roux-en Y Gastric Bypass are surgical techniques broadly employed in humans; both severely reduce the gastric surface. Paradoxically, the serum level of ghrelin in patients is preserved. We hypothesized about the role of embryonic pancreatic epsilon cells, which have the capacity to release ghrelin. We studied the changes in the epsilon cells and differentiation markers with immunostaining and ghrelin serum level and after surgery. We employed euglycemic male Wistar rats: two surgical groups (Sleeve gastrectomy and Roux-en Y Gastric Bypass) and two control groups. We reported a significant increase of ghrelin epsilon-cells in the pancreas and basal serum after Sleeve gastrectomy versus the control groups. The epsilon cellular increment was related to neogenesis, as the neurogenin-3 marker revealed. The Roux-en Y Gastric Bypass showed neither epsilon cell increase nor basal serum changes in ghrelin release. As a conclusion, we reported that the severe suppression of the fundus gastric produced the recovery of ghrelin released by the epsilon cells, which was indicative of an ontogenic embryonic pancreatic function.
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Affiliation(s)
- Alonso Camacho-Ramírez
- Surgery Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain.,Biomedical Science Research and Innovation Institute (INIBICA), Puerta del Mar University Hospital, Cádiz, Spain.,Asociación Gaditana de Apoyo al Investigador AGAI, Cádiz, Spain
| | - María Ángeles Mayo-Ossorio
- Surgery Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain.,Biomedical Science Research and Innovation Institute (INIBICA), Puerta del Mar University Hospital, Cádiz, Spain
| | - José Manuel Pacheco-García
- Surgery Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain.,Biomedical Science Research and Innovation Institute (INIBICA), Puerta del Mar University Hospital, Cádiz, Spain
| | - David Almorza-Gomar
- Biomedical Science Research and Innovation Institute (INIBICA), Puerta del Mar University Hospital, Cádiz, Spain.,Department of Operative Statistic and Research, University of Cádiz, Cádiz, Spain
| | - Antonio Ribelles-García
- Department of Human Anatomy and Embryology, Faculty of Medicine, University of Cádiz, Cádiz, Spain.,Sustainable Social Development Research Institute (INDESS), University of Cádiz, Cádiz, Spain
| | - Ana Belmonte-Núñez
- Department of Human Anatomy and Embryology, Faculty of Medicine, University of Cádiz, Cádiz, Spain
| | - J Arturo Prada-Oliveira
- Biomedical Science Research and Innovation Institute (INIBICA), Puerta del Mar University Hospital, Cádiz, Spain.,Asociación Gaditana de Apoyo al Investigador AGAI, Cádiz, Spain.,Department of Human Anatomy and Embryology, Faculty of Medicine, University of Cádiz, Cádiz, Spain.
| | - Gonzalo M Pérez-Arana
- Biomedical Science Research and Innovation Institute (INIBICA), Puerta del Mar University Hospital, Cádiz, Spain.,Department of Human Anatomy and Embryology, Faculty of Medicine, University of Cádiz, Cádiz, Spain.,Asociación Gaditana de Apoyo al Investigador AGAI, Cádiz, Spain
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Doğan S, Önmez A, Çetin MF, Özaydın İ, Pehlivan M. Residual Gastric Volume Relationship and Weight Loss After Laparoscopic Sleeve Gastrectomy. Obes Surg 2020; 30:1929-1934. [DOI: 10.1007/s11695-020-04417-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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14
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Korakas E, Kountouri A, Raptis A, Kokkinos A, Lambadiari V. Bariatric Surgery and Type 1 Diabetes: Unanswered Questions. Front Endocrinol (Lausanne) 2020; 11:525909. [PMID: 33071965 PMCID: PMC7531037 DOI: 10.3389/fendo.2020.525909] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 08/20/2020] [Indexed: 01/19/2023] Open
Abstract
In recent decades there has been an alarming increase in the prevalence of obesity in patients with type 1 diabetes leading to the development of insulin resistance and cardiometabolic complications, with mechanisms poorly clarified. While bariatric surgery has long been considered an effective treatment option for patients with type 2 diabetes, the evidence regarding its benefits on weight loss and the prevention of complications in T1DM patients is scarce, with controversial outcomes. Bariatric surgery has been associated with a significant reduction in daily insulin requirement, along with a considerable reduction in body mass index, results which were sustained in the long term. Furthermore, studies suggest that bariatric surgery in type 1 diabetes results in the improvement of comorbidities related to obesity including hypertension and dyslipidemia. However, regarding glycemic control, the reduction of mean glycosylated hemoglobin was modest or statistically insignificant in most studies. The reasons for these results are yet to be elucidated; possible explanations include preservation of beta cell mass and increased residual function post-surgery, improvement in insulin action, altered GLP-1 function, timing of surgery, and association with residual islet cell mass. A number of concerns regarding safety issues have arisen due to the reporting of peri-operative and post-operative adverse events. The most significant complications are metabolic and include diabetic ketoacidosis, severe hypoglycemia and glucose fluctuations. Further prospective clinical studies are required to provide evidence for the effect of bariatric surgery on T1DM patients. The results may offer a better knowledge for the selection of people living with diabetes who will benefit more from a metabolic surgery.
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Affiliation(s)
- Emmanouil Korakas
- Second Department of Internal Medicine, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Kountouri
- Second Department of Internal Medicine, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Raptis
- Second Department of Internal Medicine, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexander Kokkinos
- First Department of Propaedeutic Medicine, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Vaia Lambadiari
- Second Department of Internal Medicine, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
- *Correspondence: Vaia Lambadiari
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Pérez-Pevida B, Escalada J, Miras AD, Frühbeck G. Mechanisms Underlying Type 2 Diabetes Remission After Metabolic Surgery. Front Endocrinol (Lausanne) 2019; 10:641. [PMID: 31608010 PMCID: PMC6761227 DOI: 10.3389/fendo.2019.00641] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 09/04/2019] [Indexed: 01/19/2023] Open
Abstract
Type 2 diabetes prevalence is increasing dramatically worldwide. Metabolic surgery is the most effective treatment for selected patients with diabetes and/or obesity. When compared to intensive medical therapy and lifestyle intervention, metabolic surgery has shown superiority in achieving glycemic improvement, reducing number of medications and cardiovascular risk factors, which translates in long-term benefits on cardiovascular morbidity and mortality. The mechanisms underlying diabetes improvement after metabolic surgery have not yet been clearly understood but englobe a complex interaction among improvements in beta cell function and insulin secretion, insulin sensitivity, intestinal gluconeogenesis, changes in glucose utilization, and absorption by the gut and changes in the secretory pattern and morphology of adipose tissue. These are achieved through different mediators which include an enhancement in gut hormones release, especially, glucagon-like peptide 1, changes in bile acids circulation, gut microbiome, and glucose transporters expression. Therefore, this review aims to provide a comprehensive appraisal of what is known so far to better understand the mechanisms through which metabolic surgery improves glycemic control facilitating future research in the field.
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Affiliation(s)
- Belén Pérez-Pevida
- Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Imperial College London, Hammersmith Campus, London, United Kingdom
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Pamplona, Spain
- *Correspondence: Belén Pérez-Pevida
| | - Javier Escalada
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Pamplona, Spain
- Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition (CIBEROBN), ISCIII, Pamplona, Spain
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Alexander D. Miras
- Section of Investigative Medicine, Division of Diabetes, Endocrinology and Metabolism, Imperial College London, Hammersmith Campus, London, United Kingdom
| | - Gema Frühbeck
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Pamplona, Spain
- Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition (CIBEROBN), ISCIII, Pamplona, Spain
- Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Gema Frühbeck
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Sista F, Abruzzese V, Guadagni S, Carandina S, Clementi M. High Resected Gastric Volume and poorly controlled DM2 in laparoscopic sleeve gastrectomy. Ann Med Surg (Lond) 2018; 36:142-147. [PMID: 30479760 PMCID: PMC6240704 DOI: 10.1016/j.amsu.2018.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 10/14/2018] [Indexed: 01/19/2023] Open
Abstract
Background Our aim is to evaluate the effects of High Resected Gastric Volume(HRGV) on poorly Type 2 Diabetes Mellitus(DM2) after Laparoscopic Sleeve Gastrectomy(LSG). Methods 256 patients were divided into two groups according to the RGV: < 1500 mL(Group A: 131 pts) and > 1500 mL(Group B: 147 pts). % excess body mass index loss (%EBMIL), Fasting Blood Glucose (FBG), HbA1c, C peptide were assessed before surgery and at the 3rd day, 6th,12th,24th,36th month after LSG. Results A significant difference in %EBMIL between the two groups at 24 and 36 months was found. RGV was not significantly associated with DM2 in the multivariate logistic regression. FBG levels showed no differences between the two groups. A significant decrease of Hb1Ac at 6 and 12 months was found in group B. The C-peptide level showed a significant reduction at 6 and 12 months in group B. Conclusion The HRGV may play a role in the regulation of the glucose metabolism in the first year after LSG without influence in poorly DM2 control. Further studies are needed to confirm these findings.
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Affiliation(s)
- Federico Sista
- Dipartimento DISCAB, University of L'Aquila - San Salvatore Hospital, L'Aquila, Italy
| | - Valentina Abruzzese
- Dipartimento DISCAB, University of L'Aquila - San Salvatore Hospital, L'Aquila, Italy
| | - Stefano Guadagni
- Dipartimento DISCAB, University of L'Aquila - San Salvatore Hospital, L'Aquila, Italy
| | - Sergio Carandina
- ELSAN, Surgical Obesity Center (CCO), Clinique Saint Michel, Toulon, France
| | - Marco Clementi
- Dipartimento MESVA, University of L'Aquila - San Salvatore Hospital, L'Aquila, Italy
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Sista F, Abruzzese V, Carandina S, Salvatorelli A, Furia MD, Cipolloni G, Vicentini V, Guadagni S, Clementi M. Which is the correlation between carcinoid tumor and Laparoscopic Sleeve Gastrectomy? A case series and literature review. Ann Med Surg (Lond) 2018; 36:252-255. [PMID: 30568792 PMCID: PMC6287372 DOI: 10.1016/j.amsu.2018.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/31/2018] [Accepted: 09/12/2018] [Indexed: 01/19/2023] Open
Abstract
Introduction Gastric Carcinoid Tumors (GCT) are very rare in general population, but some studies evidenced a higher incidence among bariatric surgery patients. Laparoscopic Sleeve Gastrectomy (LSG) is a widely accepted procedure for the surgical treatment of morbid obesity. LSG acts both in reducing food intake and interfering with hormonal balance in the gut-brain axis. In these patients, incidental GCT diagnosis can occur both during pre-bariatric surgery investigation and during post-operative follow-up. Methods We retrospectively analyzed the database of obesity patients submitted to LSG in two different centers to find out incidence of GCT in patients treated by surgery from May 2013 to March 2018. Results From the 560 obese consecutive patients underwent LSG, we recorded two cases of patients with GCT (0.36%): the case 1 was a patient who had a pre-operative diagnosis of GTC receiving a curative LSG which totally included the carcinoid in the resected portion; the case 2 was a patient that received a curative endoscopic resection 42 months after LSG. Discussion the predisposing factors that can correlate GCT with obesity and LSG and in particular the hormonal changes have been discussed. We illustrated our experience about the management of these tumors in obese patients. Conclusion there are neither certain data which evidence a correlation between obesity and GCT, nor data to support the hypothesis of a higher incidence of GCT after bariatric surgery. Based on our experience in obese patients the finding of GCT in the pre-operatory phase is not an absolute contraindication for bariatric surgery. Recent observations showed a high incidence of Gastric Carcinoid Tumor (GCT) in candidate patients for bariatric surgery. From a multicenter experience with Laparoscopic Sleeve Gastrectomy. We retrospectively recorded two GCT cases in obese patients (the first found out during pre-operative investigations and the second one detected 52 months after surgery). The possible correlations between obesity, LSG and GTC have been discussed.
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Affiliation(s)
- Federico Sista
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100, Coppito (AQ), Italy
| | - Valentina Abruzzese
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100, Coppito (AQ), Italy
| | - Sergio Carandina
- ELSAN, Surgical Obesity Center(CCO), Clinique Saint Michel, Toulon, France
| | - Andrea Salvatorelli
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100, Coppito (AQ), Italy
| | - Marino Di Furia
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100, Coppito (AQ), Italy
| | - Gianluca Cipolloni
- Pathology Unit, Biomedical Department, San Salvatore Hospital, Via L Natali 1, 67100, Coppito (AQ), Italy
| | - Vincenzo Vicentini
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100, Coppito (AQ), Italy
| | - Stefano Guadagni
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, Via Vetoio, 67100, Coppito (AQ), Italy
| | - Marco Clementi
- Department of Medicine, Health and Life, University of L'Aquila, Piazza S, Tommasi, 67100, Coppito (AQ), Italy
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Korani MA, Sonbol A. Study of the serum level of fasting glucagon-like peptide-1 in type 2 diabetics and its relation to the glycemic profile. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2018. [DOI: 10.4103/ejim.ejim_76_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Sista F, Abruzzese V, Clementi M, Guadagni S, Montana L, Carandina S. Resolution of type 2 diabetes after sleeve gastrectomy: a 2-step hypothesis. Surg Obes Relat Dis 2017; 14:284-290. [PMID: 29339031 DOI: 10.1016/j.soard.2017.12.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 11/27/2017] [Accepted: 12/08/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Weight loss (WL) and altered gut hormonal levels are involved in glucose homeostasis after laparoscopic sleeve gastrectomy (LSG). OBJECTIVES The aim of this study was to evaluate the time-related effects of WL, ghrelin, and glucacon-like peptide-1 (GLP-1) plasma concentrations on type 2 diabetes resolution after LSG. SETTING University hospital, Italy. METHODS Ninety-one patients who underwent LSG were investigated. Insulin secretion (insulinogenic index [IGI]), insulin resistance, plasma glucose level and percentage glycated hemoglobin using the oral glucose tolerance test were assessed before surgery, on postoperative day 3, and then at 6, 12, 24, and 36 months after LSG. At the same time points, WL, ghrelin, and GLP-1 levels were determined. RESULTS During follow-up, the resolution rate of type 2 diabetes was 9.4%, 42.3%, 71.8%, 81.2%, and 91.8%, respectively. Ghrelin plasma concentrations decreased significantly after LSG (271.5 ± 24.5 pg/mL versus 122.4 ± 23.4 pg/mL, P = .04). GLP-1 plasma concentrations increased significantly after LSG (1.7 ± 2.6 pg/mL versus 2.5 ± 3.4 pg/mL, P = .04). The percentage of excess weight loss and IGI presented a positive linear correlation (r) at all follow-up time points with a strong positive correlation at 12 and 24 months. A strong negative correlation between ghrelin and IGI was recorded during the first 3 days after LSG (r = -.9). GLP-1 and IGI presented a strong positive correlation at day 3 and 6 months (i.e., .8 and .8, respectively). CONCLUSION LSG may affect glucose homeostasis by 2 different time-related modes: a first step in which the hormonal changes play a predominant role in glucose homeostasis and a second step in which the percentage excess weight loss determines the metabolic results.
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Affiliation(s)
- Federico Sista
- Department of General Surgery, Ospedale civile San Salvatore, University of L'Aquila, L'Aquila, Italy
| | - Valentina Abruzzese
- Department of General Surgery, Ospedale civile San Salvatore, University of L'Aquila, L'Aquila, Italy
| | - Marco Clementi
- Department of General Surgery, Ospedale civile San Salvatore, University of L'Aquila, L'Aquila, Italy
| | - Stefano Guadagni
- Department of General Surgery, Ospedale civile San Salvatore, University of L'Aquila, L'Aquila, Italy
| | - Laura Montana
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of digestive and metabolic surgery, Avicenne university hospital, Université Paris XIII-UFR SMBH "Léonard de Vinci", AP-HP, Bobigny, France
| | - Sergio Carandina
- ELSAN, Surgical obesity Center (CCO), Clinique Saint Michel, Toulon, France.
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Abstract
Obesity continues to increase in prevalence worldwide. Hypertension has long been associated with obesity, and weight loss continues to be a first-line therapy in the treatment of hypertension. Lifestyle modification and pharmacologic therapy, however, often meet with treatment failure. Bariatric surgery continues to be the most successful approach to sustained weight loss. This review focuses on the underlying physiologic mechanisms of obesity-hypertension, and the impact of bariatric surgery on the treatment of hypertension. Current available literature on the physiologic mechanisms of obesity-hypertension, and the major trials, meta-analyses and systematic reviews of the impact of bariatric surgery procedures on hypertension are reviewed. Evidence suggests significant improvement in obesity-hypertension in patients who undergo surgical weight-reduction procedures. Malabsorptive techniques such as the Roux-en-Y gastric bypass or surgical resection techniques such as laparoscopic sleeve gastrectomy appear to offer superior results in regards to hypertension control over restrictive techniques such as Gastric Banding. Though long-term control of hypertension following surgery remains a concern, available follow-up post-operative data of up to 10 years suggests a sustained, if lessened, effect on hypertension control over time.
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Affiliation(s)
- Jonathan G Owen
- LSUHSC Department of Medicine, Section of Nephrology and Hypertension, USA
| | - Farshid Yazdi
- LSUHSC Department of Medicine, Section of Nephrology and Hypertension, USA
| | - Efrain Reisin
- LSUHSC Department of Medicine, Section of Nephrology and Hypertension, USA
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Ye M, Huang R, Min Z, Zhang P, Wang T, Yu B. Comparison of the effect by which gastric plication and sleeve gastrectomy procedures alter metabolic and physical parameters in an obese type 2 diabetes rodent model. Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Seo D, Faintuch BL, Aparecida de Oliveira E, Faintuch J. Pancreas and liver uptake of new radiolabeled incretins (GLP-1 and Exendin-4) in models of diet-induced and diet-restricted obesity. Nucl Med Biol 2017; 49:57-64. [DOI: 10.1016/j.nucmedbio.2017.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 02/02/2017] [Accepted: 03/15/2017] [Indexed: 01/19/2023]
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