Top

Surgical Endoscopy

Published in:

01-11-2012

The preliminary clinical experience with laparoscopic duodenojejunal bypass for treatment of type 2 diabetes mellitus in non-morbidly obese patients: the 1-year result in a single institute

Authors: Kwang Yeol Paik, Wook Kim, Ki-Ho Song, Hyuk Sang Kwon, Mee Kyoung Kim, Eungkook Kim

Published in: Surgical Endoscopy | Issue 11/2012

Abstract

Background

Although various bariatric surgeries are widely known for their effect of ameliorating type 2 diabetes mellitus (T2DM), there are only a few reports demonstrating the effect of duodenojejunal bypass on T2DM. The aim of this study was to evaluate and report the clinical effects of laparoscopic duodenojejunal bypass (LDJB) in non-morbidly obese patients with T2DM.

Methods

Twelve non-morbidly obese patients with T2DM underwent LDJB. Changes in fasting blood glucose, body mass index glycosylated hemoglobin (HbA1c), and dose of antidiabetic medications were recorded prospectively during a 1-year period.

Results

Reduction in HbA1c occurred 3 months after surgery and was maintained up to 1 year, and hyperglycemia was reversed within 1 month after surgery and remained controlled at 12 months. BMI decreased significantly 1 month after surgery and then remained steady through the year. Three patients (25.0 %) stopped antidiabetic medication, seven (58.3 %) patients maintained or decreased doses, and two (16.7 %) increased doses. Seven (58.3 %) patients had a decline in HbA1c.

Conclusion

LDJB demonstrated a glycemic control effect up to 1 year on T2DM in non-morbidly obese patients.

Rubino F, Marescaux J (2004) Effect of duodenal-jejunal exclusion in a non-obese animal model of type 2 diabetes: a new perspective for an old disease. Ann Surg 239:1–11PubMedCrossRef

Rubino F (2006) Bariatric surgery: effects on glucose homeostasis. Curr Opin Clin Nutr Metab Care 9:497–507PubMedCrossRef

Pories WJ, Swanson MS, MacDonald KG, Long SB, Morris PG, Brown BM, Barakat HA, deRamon RA, Israel G, Dolezal JM, Dohm L (1995) Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg 222:339–350 discussion 350–332PubMedCrossRef

Unger RH, Eisentraut AM (1969) Entero-insular axis. Arch Intern Med 123:261–266PubMedCrossRef

Creutzfeldt W (1979) The incretin concept today. Diabetologia 16:75–85PubMedCrossRef

Korner J, Bessler M, Cirilo LJ, Conwell IM, Daud A, Restuccia NL, Wardlaw SL (2005) Effects of Roux-en-Y gastric bypass surgery on fasting and postprandial concentrations of plasma ghrelin, peptide YY, and insulin. J Clin Endocrinol Metab 90:359–365PubMedCrossRef

le Roux CW, Aylwin SJB, Batterham RL, Borg CM, Coyle F, Prasad V, Shurey S, Ghatei MA, Patel AG, Bloom SR (2006) Gut hormone profiles following bariatric surgery favor an anorectic state, facilitate weight loss, and improve metabolic parameters. Ann Surg 243:108–114PubMedCrossRef

Rubino F, Forgione A, Cummings DE, Vix M, Gnuli D, Mingrone G, Castagneto M, Marescaux J (2006) The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes. Ann Surg 244:741–749PubMedCrossRef

Guidone C, Manco M, Valera-Mora E, Iaconelli A, Gniuli D, Mari A, Nanni G, Castagneto M, Calvani M, Mingrone G (2006) Mechanisms of recovery from type 2 diabetes after malabsorptive bariatric surgery. Diabetes 55:2025–2031PubMedCrossRef

10.

Morinigo R, Lacy AM, Casamitjana R, Delgado S, Gomis R, Vidal J (2006) GLP-1 and changes in glucose tolerance following gastric bypass surgery in morbidly obese subjects. Obes Surg 16:1594–1601PubMedCrossRef

11.

Cohen RV, Schiavon CA, Pinheiro JS, Correa JL, Rubino F (2007) Duodenal-jejunal bypass for the treatment of type 2 diabetes in patients with body mass index of 22-34 kg/m²: a report of 2 cases. Surg Obes Relat Dis 3:195–197PubMedCrossRef

12.

Lee HC, Kim MK, Kwon HS, Kim E, Song KH (2010) Early changes in incretin secretion after laparoscopic duodenal-jejunal bypass surgery in type 2 diabetic patients. Obes Surg 20:1530–1535PubMedCrossRef

13.

Ramos AC, Galvao Neto MP, de Souza YM, Galvao M, Murakami AH, Silva AC, Canseco EG, Santamaria R, Zambrano TA (2009) Laparoscopic duodenal-jejunal exclusion in the treatment of type 2 diabetes mellitus in patients with BMI < 30 kg/m² (LBMI). Obes Surg 19:307–312PubMedCrossRef

14.

Ferzli GS, Dominique E, Ciaglia M, Bluth MH, Gonzalez A, Fingerhut A (2009) Clinical improvement after duodenojejunal bypass for nonobese type 2 diabetes despite minimal improvement in glycemic homeostasis. World J Surg 33:972–979PubMedCrossRef

15.

Geloneze B, Geloneze SR, Fiori C, Stabe C, Tambascia MA, Chaim EA, Astiarraga BD, Pareja JC (2009) Surgery for nonobese type 2 diabetic patients: an interventional study with duodenal-jejunal exclusion. Obes Surg 19:1077–1083PubMedCrossRef

16.

Buse JB, Caprio S, Cefalu WT, Ceriello A, Del Prato S, Inzucchi SE, McLaughlin S, Phillips GL II, Robertson RP, Rubino F, Kahn R, Kirkman MS (2009) How do we define cure of diabetes? Diabetes Care 32:2133–2135PubMedCrossRef

17.

Schauer PR, Burguera B, Ikramuddin S, Cottam D, Gourash W, Hamad G, Eid GM, Mattar S, Ramanathan R, Barinas-Mitchel E, Rao RH, Kuller L, Kelley D (2003) Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg 238:467–484 discussion 484–465PubMed

18.

Torquati A, Lutfi R, Abumrad N, Richards WO (2005) Is Roux-en-Y gastric bypass surgery the most effective treatment for type 2 diabetes mellitus in morbidly obese patients? J Gastrointest Surg 9:1112–1116 discussion 1117–1118PubMedCrossRef

Title: The preliminary clinical experience with laparoscopic duodenojejunal bypass for treatment of type 2 diabetes mellitus in non-morbidly obese patients: the 1-year result in a single institute
Authors: Kwang Yeol Paik
Wook Kim
Ki-Ho Song
Hyuk Sang Kwon
Mee Kyoung Kim
Eungkook Kim
Publication date: 01-11-2012
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 11/2012
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-012-2341-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The preliminary clinical experience with laparoscopic duodenojejunal bypass for treatment of type 2 diabetes mellitus in non-morbidly obese patients: the 1-year result in a single institute

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 11/2012

Early experience of laparoscopic complete en bloc excision for choledochal cysts in adults

Laparoscopic splenectomy for massive splenomegaly in benign hematological diseases

Feasibility of transanal minimally invasive surgery for mid-rectal lesions

Stenting versus gastrojejunostomy for management of malignant gastric outlet obstruction: comparison of clinical outcomes and costs

A comparative study of the surgical outcomes of robotic and conventional open modified radical neck dissection for papillary thyroid carcinoma with lateral neck node metastasis

Clinical outcomes of patients who experienced perforation associated with endoscopic retrograde cholangiopancreatography