Effect of sleeve gastrectomy-transit bipartition on diabetic rat with obesity and change of terminal esophageal mucosa_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Meng , HOU Dongsheng , YAO Libin , HONG Jian ,  ZHU Xiaocheng

Department of Gastrointestinal Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, P. R. China;

Corresponding author：

ZHU Xiaocheng, Email: zhuxccf@163.com

Keywords：

rat; type 2 diabetes mellitus; obesity; sleeve gastrectomy-transit bipartition; esophageal reflux

DOI：

10.7507/1007-9424.202109019

Video：

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Objective To investigate effects of sleeve gastrectomy (SG)-transit bipartition (SG-TB) and simple SG on bariatric and anti-diabetic and protective effect on esophagus reflux. Methods A total of 36 male Sprague-Dawley rats were used to successfully induce the obesity with type 2 diabetes mellitus (T2DM) model by dietary feeding and receiving intraperitoneal injection of streptozotocin (35 mg/kg), then were randomly averagely divided into SG, SG-TB, and sham operation (SO) groups according to the surgical methods, and 8 rats from each procedure were randomly selected and included to use for experimental observation. The observation period was 12 weeks. The changes of terminal esophageal mucosa were observed at the 12th week after operation. The body weight and food intake were measured every 2 weeks after operation. The fasting blood glucose (FBG), oral glucose tolerance test (OGTT) and insulin tolerance test (ITT) blood glucose levels were measured before operation and at the 4th and 12th week after operation. And the changes of glucagon like peptide-1 (GLP-1) and insulin levels were measured before operation and at the 12th week after operation. Results There were no significant differences in all indexes among the 3 groups before operation (P>0.05). ① No esophageal papillomatosis was observed in the SG-TB group at the 12th week after operation, but more severe esophageal papillomatosis was observed in the SG group, and the mucosal height in the SG-TB group was lower than that in the SG group (P<0.05). ② From the 4th week after operation, the body weight and food intake of the SG-TB group and SG group were lower than the SO group (P<0.05), and their changes of these two groups over time were generally stable. While no significant difference was found in the reduction of body weight between the SG-TB group and the SG group (P>0.05), however the food intakes of the SG-TB group were higher than the SG group at the 10th and 12th week after operation (P<0.05). ③ The levels of FBG, OGTT and ITT blood glucoses in the SG-TB group and SG group were lower than in the SO group at the 4th and 12th week after operation (P<0.05) and remained stable after operation. However, no significant difference was found in the FBG and ITT blood glucose level between the SG-TB group and the SG group (P>0.05), while the level of OGTT blood glucose in the SG-TB group was lower than that in the SG group at the 12th week after operation (P<0.05). ④ The levels of GLP-1 in the SG-TB group and SG group were higher than in the SO group and still higher than before operation (P<0.05), while the insulin levels were lower than in the SO group and lower than before operation (P<0.05). Conclusions From preliminary results of this study, change of terminal esophageal mucosa after SG-TB is weaker than that of SG operation, and it is found that SG-TB surgery shows a better trend in blood glucose control as compared with SG operation. However, due to the limitations of sample size, further research and anti-reflux effect of SG-TB operation still need to be verified.

Citation： WANG Meng, HOU Dongsheng, YAO Libin, HONG Jian, ZHU Xiaocheng. Effect of sleeve gastrectomy-transit bipartition on diabetic rat with obesity and change of terminal esophageal mucosa. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(7): 862-868. doi: 10.7507/1007-9424.202109019 Copy

1.	Cummings DE, Rubino F. Metabolic surgery for the treatment of type 2 diabetes in obese individuals. Diabetologia, 2018, 61(2): 257-264.
2.	Schauer PR, Mingrone G, Ikramuddin S, et al. Clinical outcomes of metabolic surgery: efficacy of glycemic control, weight loss, and remission of diabetes. Diabetes Care, 2016, 39(6): 902-911.
3.	Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery and endoluminal procedures: IFSO worldwide survey 2014. Obes Surg, 2017, 27(9): 2279-2289.
4.	Welbourn R, Hollyman M, Kinsman R, et al. Bariatric surgery worldwide: baseline demographic description and one-year outcomes from the fourth IFSO global registry report 2018. Obes Surg, 2019, 29(3): 782-795.
5.	Peterli R, Wölnerhanssen BK, Peters T, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss in patients with morbid obesity: the SM-BOSS randomized clinical trial. JAMA, 2018, 319(3): 255-265.
6.	Yeung KTD, Penney N, Ashrafian L, et al. Does sleeve gastrectomy expose the distal esophagus to severe reflux?: a systematic review and meta-analysis. Ann Surg, 2020, 271(2): 257-265.
7.	Genco A, Castagneto-Gissey L, Lorenzo M, et al. Esophageal adenocarcinoma after sleeve gastrectomy: actual or potential threat? Italian series and literature review. Surg Obes Relat Dis, 2021, 17(5): 848-854.
8.	Felsenreich DM, Langer FB, Kefurt R, et al. Weight loss, weight regain, and conversions to Roux-en-Y gastric bypass: 10-year results of laparoscopic sleeve gastrectomy. Surg Obes Relat Dis, 2016, 12(9): 1655-1662.
9.	Felinska E, Billeter A, Nickel F, et al. Do we understand the pathophysiology of GERD after sleeve gastrectomy? Ann NY Acad Sci, 2020, 1482(1): 26-35.
10.	Santoro S, Malzoni CE, Velhote MC, et al. Digestive adaptation with intestinal reserve: a neuroendocrine-based operation for morbid obesity. Obes Surg, 2006, 16(10): 1371-1379.
11.	Yormaz S, Yılmaz H, Ece I, et al. Laparoscopic ileal interposition with diverted sleeve gastrectomy versus laparoscopic transit bipartition with sleeve gastrectomy for better glycemic outcomes in T2DM patients. Obes Surg, 2018, 28(1): 77-86.
12.	Cagiltay E, Celik A, Dixon JB, et al. Effects of different metabolic states and surgical models on glucose metabolism and secretion of ileal L-cell peptides: results from the HIPER-1 study. Diabet Med, 2020, 37(4): 697-704.
13.	Topart P, Becouarn G, Finel JB. Is transit bipartition a better alternative to biliopancreatic diversion with duodenal switch for superobesity? Comparison of the early results of both procedures. Surg Obes Relat Dis, 2020, 16(4): 497-502.
14.	Topart P, Becouarn G, Finel JB. Comparison of 2-year results of Roux-en-Y gastric bypass and transit bipartition with sleeve gastrectomy for superobesity. Obes Surg, 2020, 30(9): 3402-3407.
15.	Ece I, Yilmaz H, Yormaz S, et al. The short-term effects of transit bipartition with sleeve gastrectomy and distal-Roux-en-Y gastric bypass on glycemic control, weight loss, and nutritional status in morbidly obese and type 2 diabetes mellitus patients. Obes Surg, 2021, 31(5): 2062-2071.
16.	Altieri MS, Shroyer KR, Pryor A, et al. The association between sleeve gastrectomy and histopathologic changes consistent with esophagitis in a rodent model. Surg Obes Relat Dis, 2015, 11(6): 1289-1294.
17.	Widjaja J, Dolo PR, Zhang Q, et al. Bypassed and preserved stomach resulted in superior glucose control in Sprague-Dawley rats with streptozotocin-induced diabetes. Sci Rep, 2019, 9(1): 9981. doi: 10.1038/s41598-019-46418-y.
18.	Liu P, Widjaja J, Dolo PR, et al. Comparing the anti-diabetic effect of sleeve gastrectomy with transit bipartition against sleeve gastrectomy and Roux-en-Y gastric bypass using a diabetic rodent model. Obes Surg, 2021, 31(5): 2203-2210.
19.	Panteliou E, Miras AD. What is the role of bariatric surgery in the management of obesity? Climacteric, 2017, 20(2): 97-102.
20.	李梦依, 刘洋, 张松海. 大中华减重与代谢手术数据库2020年度报告. 中国实用外科杂志, 2021, 41(5): 533-542.
21.	Capoccia D, Coccia F, Guarisco G, et al. Long-term metabolic effects of laparoscopic sleeve gastrectomy. Obes Surg, 2018, 28(8): 2289-2296.
22.	Mala T. The gastric remnant in Roux-en-Y gastric bypass: challenges and possibilities. J Clin Gastroenterol, 2016, 50(7): 527-531.
23.	Santoro S, Castro LC, Velhote MC et al. Sleeve gastrectomy with transit bipartition: a potent intervention for metabolic syndrome and obesity. Ann Surg, 2012, 256(1): 104-110.
24.	Toro JP, Lin E, Patel AD, et al. Association of radiographic morphology with early gastroesophageal reflux disease and satiety control after sleeve gastrectomy. J Am Coll Surg, 2014, 219(3): 430-438.
25.	Yehoshua RT, Eidelman LA, Stein M, et al. Laparoscopic sleeve gastrectomy—volume and pressure assessment. Obes Surg, 2008, 18(9): 1083-1088.
26.	Lazoura O, Zacharoulis D, Triantafyllidis G, et al. Symptoms of gastroesophageal reflux following laparoscopic sleeve gastrectomy are related to the final shape of the sleeve as depicted by radiology. Obes Surg, 2011, 21(3): 295-299.
27.	Fisichella PM, Schlottmann F, Patti MG. Evaluation of gastroesophageal reflux disease. Updates Surg, 2018, 70(3): 309-313.

1. Cummings DE, Rubino F. Metabolic surgery for the treatment of type 2 diabetes in obese individuals. Diabetologia, 2018, 61(2): 257-264.
2. Schauer PR, Mingrone G, Ikramuddin S, et al. Clinical outcomes of metabolic surgery: efficacy of glycemic control, weight loss, and remission of diabetes. Diabetes Care, 2016, 39(6): 902-911.
3. Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery and endoluminal procedures: IFSO worldwide survey 2014. Obes Surg, 2017, 27(9): 2279-2289.
4. Welbourn R, Hollyman M, Kinsman R, et al. Bariatric surgery worldwide: baseline demographic description and one-year outcomes from the fourth IFSO global registry report 2018. Obes Surg, 2019, 29(3): 782-795.
5. Peterli R, Wölnerhanssen BK, Peters T, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss in patients with morbid obesity: the SM-BOSS randomized clinical trial. JAMA, 2018, 319(3): 255-265.
6. Yeung KTD, Penney N, Ashrafian L, et al. Does sleeve gastrectomy expose the distal esophagus to severe reflux?: a systematic review and meta-analysis. Ann Surg, 2020, 271(2): 257-265.
7. Genco A, Castagneto-Gissey L, Lorenzo M, et al. Esophageal adenocarcinoma after sleeve gastrectomy: actual or potential threat? Italian series and literature review. Surg Obes Relat Dis, 2021, 17(5): 848-854.
8. Felsenreich DM, Langer FB, Kefurt R, et al. Weight loss, weight regain, and conversions to Roux-en-Y gastric bypass: 10-year results of laparoscopic sleeve gastrectomy. Surg Obes Relat Dis, 2016, 12(9): 1655-1662.
9. Felinska E, Billeter A, Nickel F, et al. Do we understand the pathophysiology of GERD after sleeve gastrectomy? Ann NY Acad Sci, 2020, 1482(1): 26-35.
10. Santoro S, Malzoni CE, Velhote MC, et al. Digestive adaptation with intestinal reserve: a neuroendocrine-based operation for morbid obesity. Obes Surg, 2006, 16(10): 1371-1379.
11. Yormaz S, Yılmaz H, Ece I, et al. Laparoscopic ileal interposition with diverted sleeve gastrectomy versus laparoscopic transit bipartition with sleeve gastrectomy for better glycemic outcomes in T2DM patients. Obes Surg, 2018, 28(1): 77-86.
12. Cagiltay E, Celik A, Dixon JB, et al. Effects of different metabolic states and surgical models on glucose metabolism and secretion of ileal L-cell peptides: results from the HIPER-1 study. Diabet Med, 2020, 37(4): 697-704.
13. Topart P, Becouarn G, Finel JB. Is transit bipartition a better alternative to biliopancreatic diversion with duodenal switch for superobesity? Comparison of the early results of both procedures. Surg Obes Relat Dis, 2020, 16(4): 497-502.
14. Topart P, Becouarn G, Finel JB. Comparison of 2-year results of Roux-en-Y gastric bypass and transit bipartition with sleeve gastrectomy for superobesity. Obes Surg, 2020, 30(9): 3402-3407.
15. Ece I, Yilmaz H, Yormaz S, et al. The short-term effects of transit bipartition with sleeve gastrectomy and distal-Roux-en-Y gastric bypass on glycemic control, weight loss, and nutritional status in morbidly obese and type 2 diabetes mellitus patients. Obes Surg, 2021, 31(5): 2062-2071.
16. Altieri MS, Shroyer KR, Pryor A, et al. The association between sleeve gastrectomy and histopathologic changes consistent with esophagitis in a rodent model. Surg Obes Relat Dis, 2015, 11(6): 1289-1294.
17. Widjaja J, Dolo PR, Zhang Q, et al. Bypassed and preserved stomach resulted in superior glucose control in Sprague-Dawley rats with streptozotocin-induced diabetes. Sci Rep, 2019, 9(1): 9981. doi: 10.1038/s41598-019-46418-y.
18. Liu P, Widjaja J, Dolo PR, et al. Comparing the anti-diabetic effect of sleeve gastrectomy with transit bipartition against sleeve gastrectomy and Roux-en-Y gastric bypass using a diabetic rodent model. Obes Surg, 2021, 31(5): 2203-2210.
19. Panteliou E, Miras AD. What is the role of bariatric surgery in the management of obesity? Climacteric, 2017, 20(2): 97-102.
20. 李梦依, 刘洋, 张松海. 大中华减重与代谢手术数据库2020年度报告. 中国实用外科杂志, 2021, 41(5): 533-542.
21. Capoccia D, Coccia F, Guarisco G, et al. Long-term metabolic effects of laparoscopic sleeve gastrectomy. Obes Surg, 2018, 28(8): 2289-2296.
22. Mala T. The gastric remnant in Roux-en-Y gastric bypass: challenges and possibilities. J Clin Gastroenterol, 2016, 50(7): 527-531.
23. Santoro S, Castro LC, Velhote MC et al. Sleeve gastrectomy with transit bipartition: a potent intervention for metabolic syndrome and obesity. Ann Surg, 2012, 256(1): 104-110.
24. Toro JP, Lin E, Patel AD, et al. Association of radiographic morphology with early gastroesophageal reflux disease and satiety control after sleeve gastrectomy. J Am Coll Surg, 2014, 219(3): 430-438.
25. Yehoshua RT, Eidelman LA, Stein M, et al. Laparoscopic sleeve gastrectomy—volume and pressure assessment. Obes Surg, 2008, 18(9): 1083-1088.
26. Lazoura O, Zacharoulis D, Triantafyllidis G, et al. Symptoms of gastroesophageal reflux following laparoscopic sleeve gastrectomy are related to the final shape of the sleeve as depicted by radiology. Obes Surg, 2011, 21(3): 295-299.
27. Fisichella PM, Schlottmann F, Patti MG. Evaluation of gastroesophageal reflux disease. Updates Surg, 2018, 70(3): 309-313.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effect of sleeve gastrectomy-transit bipartition on diabetic rat with obesity and change of terminal esophageal mucosa

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