The effect of duodenojejunostomy and sleeve gastrectomy on type 2 diabetes mellitus and gastrin secretion in Goto-Kakizaki rats

Abstract

Sleeve gastrectomy induces hypergastrinemia, lowers HbA1c, and improves glycemic control in Goto-Kakizaki rats. Sleeve gastrectomy is superior to duodenojejunostomy as treatment of type 2 diabetes mellitus in this animal model.

Sleeve gastrectomy, but not duodenojejunostomy, preserves total beta-cell mass in Goto-Kakizaki rats evaluated by three-dimensional optical projection tomography

“…1D). Although rats after SG had lower HbA1c levels compared to DJ and presented with a decreased fasting blood glucose versus both DJ and sham operation, we found a more clear difference 2 months earlier between the SG-and shamoperated animals, e.g., difference in HbA1c levels [18]. The unfortunate loss of two animals in the SG group and one animal in the DJ groups naturally affects statistical power, and HbA1c-levels in GK-rats reflect only the glycemic state of approximately 60 days [31].…”

“…The results from a 36-week follow-up of 27 male GotoKakizaki rats (Taconic, Hudson, NY) after duodenojejunostomy (DJ), sleeve gastrectomy (SG) and sham operation have previously been reported [18]. In addition, four age-and sex-matched sham-operated Wistar rats (Taconic, Hudson, NY) were included as non-diabetic controls (W-sham).…”

“…In a previous study, we found that sleeve gastrectomy (SG) had lower HbA1c, lower fasting blood glucose, lower area under the curve (AUC) during oral glucose tolerance test (OGTT) and improved lipid profile during 36 weeks of follow-up compared to duodenojejunostomy (DJ) and sham operation [18]. Furthermore, gastrin was markedly elevated in the SG group, while GLP-1 levels were increased for the DJ group compared to sham-operated animals.…”

“…In general, the anti-diabetic effect of surgery is present prior to significant weight loss, indicating that the anatomical circumvention or manipulation per se is the underlying contributor to T2DM remission [13][14][15]. Altered secretion of gastrointestinal hormones such as glucagon-like peptide 1 (GLP-1), ghrelin and gastrin has been attributed to the rapid postoperative improvement in glycemic control [16][17][18]. All these hormones regulate pancreatic BCM in preclinical studies [19][20][21].…”

Relationship between gastric pouch and weight loss after laparoscopic sleeve gastrectomy

“…Now it is considered a full primary bariatric procedure, safe and effective even as conversion procedure after failure or complications of other bariatric operations [8,9]. Several different mechanisms have been postulated to lead to weight loss after LSG, such as the reduced expansibility and capacity of the sleeved stomach [10], the higher pressure induced by solid food intake [11], improved mitochondrial respiration [12] and insulin sensitivity [13,14], and lower plasma levels of ghrelin [15], mainly produced in the fundic region by specialized gastric cells [16,17]. In common clinical practice, the radiological followup was usually indicated only for patients with symptoms or unsatisfactory weight loss curve, but the correlation between gastric fundus at follow-up upper gastrointestinal series (UGS) and weight loss remains unclear [18].…”