Ilial Transposition and Enteroglucagon/GLP-1 in Obesity (and Diabetic?) Surgery

Abstract

It appears from all that is now known about GLP-1 that ileal transposition would be an ideal operation for treatment of type 2 DM. Release of enteroglucagon from the ileum has probably contributed to weight control in bypass operations for obesity, but the effect has been obscured by the associated malabsorption. The release of GLP-1 after meals has probably been beneficial to patients treated with gastric bypass who had type 2 DM. This is a recommendation for well-planned studies of ileal transposition in the treatment of type 2 DM and obesity. Ileal transposition is not recommended for general use until such studies have shown safety, efficacy, and the requirements for patient selection.

Sleeve Gastrectomy With Modified Jejunoileal Bypass Model in Goto-Kakizaki Rats

“…4 JIB was a widely performed procedure for morbid obesity during the 1970s, and it led to intestinal malabsorption for reducing weight and decreasing blood glucose; however, because of the high morbidity rates, its popularity declined, and most surgeons no longer perform the operation. 11,12 Yet, with modifications to the JIB, it is still being performed in certain centers in order to reduce severe complications. [20][21][22] Therefore, we first established the surgical model of SG/MJIB in GK rats and explored a possible solution to stabilize the lasting improvement of diabetes.…”

“…Although this surgical method is relatively safe, the glycemic regulatory effect is far from satisfactory; complications, such as intragastric erosion or band slippage, may occur 9 ; and the reoperation rate may be .10%. 10 Jejunoileal bypass (JIB) has been the most effective T2DM treatment 11 ; however, because of its severe complications, JIB has been abandoned by most surgeons. 12 Other procedures that combine gastritis and malabsorption, such as Roux-en-Y bypass, exclude most parts of the stomach, making this organ and the biliary ducts inaccessible to the usual endoscopic examinations, 13,14 which is not very suitable in high-risk patients.…”

Swedish Obese Subjects (SOS)*

“…Although the weight loss was 38.6 kg in the gastric bypass group but only 26.7 kg in the combined VBG and banding group, the energy intake before and after surgery did not differ between the groups (Figure 35.4). It has been shown that gastric bypass is associated with increased energy expenditure (9), perhaps due to an increased secretion of glucagon-like peptide 1 (GLP-1) (10,11).…”

Structural changes in intestinal enteroendocrine cells after ileal interposition in normal rats

“…56 Fast and permanent improvements in glucose control were observed in patients immediately after bariatric surgery, and surgery eliminated the need for glycaemia-controlling drugs in most cases. 57,58 The beneficial effects of bariatric surgery on glycaemic control also depend on the duration of disease 59 and the type of surgical intervention; interventions based solely on stomach restriction, such as adjustable gastric bands, proved to be less effective in improving T2D than procedures involving substantial amounts of intestinal bypass 55,60,61 or significant increases in digestive transit speed, such as vertical gastrectomy.…”