Document Detail

Metabolic and hormonal changes after laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy: a randomized, prospective trial.
MedLine Citation:
PMID:  22354457     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The mechanisms of amelioration of glycemic control early after laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) are not fully understood.
METHODS: In this prospective, randomized 1-year trial, outcomes of LRYGB and LSG patients were compared, focusing on possibly responsible mechanisms. Twelve patients were randomized to LRYGB and 11 to LSG. These non-diabetic patients were investigated before and 1 week, 3 months, and 12 months after surgery. A standard test meal was given after an overnight fast, and blood samples were collected before, during, and after food intake for hormone profiles (cholecystokinin (CCK), ghrelin, glucagon-like peptide 1 (GLP-1), peptide YY (PYY)).
RESULTS: In both groups, body weight and BMI decreased markedly and comparably leading to an identical improvement of abnormal glycemic control (HOMA index). Post-surgery, patients had markedly increased postprandial plasma GLP-1 and PYY levels (p < 0.05) with ensuing improvement in glucose homeostasis. At 12 months, LRYGB ghrelin levels approached preoperative values. The postprandial, physiologic fluctuation returned, however, while LSG ghrelin levels were still markedly attenuated. One year postoperatively, CCK concentrations after test meals increased less in the LRYGB group than they did in the LSG group, with the latter showing significantly higher maximal CCK concentrations (p < 0.012 vs. LRYGB).
CONCLUSIONS: Bypassing the foregut is not the only mechanism responsible for improved glucose homeostasis. The balance between foregut (ghrelin, CCK) and hindgut (GLP-1, PYY) hormones is a key to understanding the underlying mechanisms.
Ralph Peterli; Robert E Steinert; Bettina Woelnerhanssen; Thomas Peters; Caroline Christoffel-Courtin; Markus Gass; Beatrice Kern; Markus von Fluee; Christoph Beglinger
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Obesity surgery     Volume:  22     ISSN:  1708-0428     ISO Abbreviation:  Obes Surg     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-04-05     Completed Date:  2012-07-16     Revised Date:  2013-06-26    
Medline Journal Info:
Nlm Unique ID:  9106714     Medline TA:  Obes Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  740-8     Citation Subset:  IM    
Department of Surgery, St Claraspital, 4016 Basel, Switzerland.
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MeSH Terms
Blood Glucose / metabolism*
Cholecystokinin / blood
Gastric Bypass*
Gastrointestinal Hormones / blood*
Ghrelin / blood
Glucagon-Like Peptide 1 / blood
Hemoglobin A, Glycosylated / metabolism*
Obesity, Morbid / blood*,  surgery
Peptide YY / blood
Postprandial Period
Prospective Studies
Weight Loss
Reg. No./Substance:
0/Blood Glucose; 0/Gastrointestinal Hormones; 0/Ghrelin; 0/Hemoglobin A, Glycosylated; 0/hemoglobin A1c protein, human; 106388-42-5/Peptide YY; 89750-14-1/Glucagon-Like Peptide 1; 9011-97-6/Cholecystokinin

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