Laparoscopic Sleeve Gastrectomy Versus Banded Roux-en-Y Gastric Bypass for Diabetes and Obesity: a Prospective Randomised Double-Blind Trial

Murphy, Rinki; Clarke, Michael; Evennett, Nicholas; Robinson, Steven J; Humphreys, Martyn Lee; Hammodat, Hisham; Jones, Bronwen; Kim, David D.; Cutfield, Richard; Johnson, Malcolm H.; Plank, Lindsay D.; Booth, Michael

doi:10.1007/s11695-017-2872-6

Cited by 68 publications

(49 citation statements)

References 34 publications

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“…The literature search identified 2650 unique citations, whereof 2625 were excluded because of irrelevant content, duplication, or non‐English language (Figure ). Of the 25 studies that were full‐text screened, 13 did not meet the inclusion criteria either because follow‐up time was too short, the authors did not differentiate between improvement and remission of T2DM, other bariatric procedures were performed (mini gastric bypass, banded RYGB, and metabolic gastric bypass), the study was not an RCT, no patients in the SG‐group had T2DM, or the study included a subpopulation of an already included RCT . We detected two studies that had been performed in the same study population, and of these, only the study referring to a clinical trial registry number was included .…”

Section: Resultsmentioning

confidence: 99%

“…However, in this review, the landmark STAMPEDE trial and the RCT by Keidar et al were not included in the meta‐analysis of studies with 1‐year follow‐up . This review also differed from the present review considering that other variants of gastric bypass, such as banded and mini gastric bypass, were included, and understandably, it could not include the recently published results from the Oseberg‐trial.…”

Section: Discussionmentioning

confidence: 95%

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Comparison of the effect of Roux‐en‐Y gastric bypass and sleeve gastrectomy on remission of type 2 diabetes: A systematic review and meta‐analysis of randomized controlled trials

et al. 2020

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Bariatric surgery is an effective treatment option for patients with type 2 diabetes mellitus (T2DM) and obesity. This study aims to compare the effects of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) on remission of T2DM. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials weresearched for studies published between database inception and 21 November 2019.A meta-analysis, using a random effects model, was performed to calculate relative risk (RR) of T2DM remission between the groups in randomized controlled trials (RCTs). Of 2650 records identified, 12 records from 10 different RCTs were finally included. The studies comprised 705 patients with follow-up from 1 to 5 years. The remission rate of T2DM at 1 year was higher among those undergoing RYGB (156/276, 57%) compared with those undergoing SG (128/275, 47%), RR (95% CI) 1.20 (1.00-1.45), P = .047, I 2 = 24.9%, moderate-quality evidence. Among studies with 2-to 5-year follow-up, there was no difference in remission rates between the RYGB (132/263, 50%) and SG (121/266, 46%) groups, RR 1.06 (0.94-1.20), P = .34, I 2 = 0.0%, low-quality evidence. RYGB resulted in a higher rate of T2DM remission compared with SG after 1 year. The T2DM remission rates did not differ in studies with 2-to 5-year follow-up. K E Y W O R D SRoux-en-Y gastric bypass, sleeve gastrectomy, systematic review, type 2 diabetes mellitus Abbreviations: BMI, body mass index; CI, confidence interval; RCT, randomized controlled trial; RR, relative risk; RYGB, Roux-en-Y gastric bypass; SD, standard deviation; SG, sleeve gastrectomy; T2DM, type 2 diabetes mellitus.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 95%

Comparison of the effect of Roux‐en‐Y gastric bypass and sleeve gastrectomy on remission of type 2 diabetes: A systematic review and meta‐analysis of randomized controlled trials

et al. 2020

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“…In the context of T2D remission, only one study has focused on the comparison of microbial changes between patients experiencing or not experiencing DR post-BS 148 . Even though only 14 patients were examined (7 RYGB, 7 VSG), Murphy et al, showed that presurgical GM composition differed between patients who eventually experienced DR as compared to those who did not.…”

Section: Gut Microbiota Compositional Modificationsmentioning

confidence: 99%

Impact of bariatric surgery on type 2 diabetes: contribution of inflammation and gut microbiome?

et al. 2019

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Obesity is a chronic low-grade inflammatory disease (both at the systemic and adipose tissue level) that continues to rise worldwide. It is associated with an abundance of comorbidities, including type 2 diabetes (T2D). Bariatric surgery, which induces modifications of the intestinal tract, is to date the most successful treatment for obesity. Its use has dramatically increased in number as it enables both weight reduction and metabolic improvements, with 60% of patients even achieving diabetes remission. Several mechanisms are actually demonstrated to be involved in those clinical improvements. Importantly, both obesity and T2D share many phenotypic characteristics, including increased systemic and adipose tissue inflammation, as well as gut microbiota dysbiosis. These characteristics are deeply modulated after bariatric surgery. This review will specifically focus on the host metabolic changes induced by bariatric surgery in regards of the induced gut architectural changes, as well as on the modifications in the inflammatory tone and gut microbiota observed subsequently to bariatric surgery induced weight loss.

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“…The two most widely used types of bariatric surgery are currently VSG and Roux-n-Y-Gastric-Bypass (46). Despite the similar metabolic outcomes between the two procedures, VSG is reported to have lower mortality in mice (47,48), but also allows for gradual weight regain, which is why it was chosen for this study (11,49).…”

Section: Discussionmentioning

confidence: 99%

Bariatric surgery normalizes circulating glucocorticoid levels and lowers glucocorticoid action tissue-selectively in mice

Akalestou

López-Noriega

Christakis

et al. 2020

Preprint

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BackgroundGlucocorticoids produced by the adrenal cortex are essential for the maintenance of metabolic homeostasis. Glucocorticoid activation is catalyzed by 11β-hydroxysteroid dehydrogenase 1 (11β-HSD1) and signalling is achieved through the glucocorticoid receptor (GR), a ligand-dependent transcription factor. Excess glucocorticoids are associated with insulin resistance and hyperglycaemia. A small number of studies have investigated the effects of bariatric surgery, a gastrointestinal procedure known to improve insulin sensitivity, on glucocorticoid metabolism, but the hypothesised mechanism is assumed to be via weight loss.AimTo investigate the effect of bariatric surgery on glucocorticoid metabolism in lean and obese mice.MethodsLean mice and HFD mice underwent Vertical Sleeve Gastrectomy (VSG) or sham surgery. Glucose and insulin tolerance tests were performed at four and ten weeks post operatively and circulating corticosterone was measured. Liver and adipose tissues were harvested from fed mice and 11β-HSD1 and GR levels were measured by quantitative RT-PCR or Western (immuno-) blotting, respectively.ResultsVSG did not cause excess weight loss in lean mice when compared to sham operated mice. However, both lean and HFD VSG mice displayed significantly improved glucose clearance and insulin sensitivity. Remarkably, VSG restores physiological corticosterone production in HFD mice and reduces11β-HSD1 levels at four and ten weeks post-surgery. Additionally, lean mice displayed significantly lowered mRNA levels of 11β-HSD1 in subcutaneous adipose tissue and GR in liver.ConclusionsBariatric surgery improves insulin sensitivity and reduces glucocorticoid activation at tissular level, under physiological and pathophysiological (obesity) conditions, irrespective of weight loss. The reduction of glucocorticoid exposure may represent an additional contribution to the health benefits of bariatric surgery. These findings point towards a physiologically relevant gut-adrenal axis.

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Laparoscopic Sleeve Gastrectomy Versus Banded Roux-en-Y Gastric Bypass for Diabetes and Obesity: a Prospective Randomised Double-Blind Trial

Abstract: Prospectively registered at Australia and New Zealand Clinical Trials Register (ACTRN 12611000751976) and retrospectively registered at Clinical Trials (NCT1486680).

Cited by 68 publications

References 34 publications

Comparison of the effect of Roux‐en‐Y gastric bypass and sleeve gastrectomy on remission of type 2 diabetes: A systematic review and meta‐analysis of randomized controlled trials

Comparison of the effect of Roux‐en‐Y gastric bypass and sleeve gastrectomy on remission of type 2 diabetes: A systematic review and meta‐analysis of randomized controlled trials

Impact of bariatric surgery on type 2 diabetes: contribution of inflammation and gut microbiome?

Bariatric surgery normalizes circulating glucocorticoid levels and lowers glucocorticoid action tissue-selectively in mice

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