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Randomized Controlled Trial
. 2012 May;22(5):740-8.
doi: 10.1007/s11695-012-0622-3.

Metabolic and hormonal changes after laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy: a randomized, prospective trial

Ralph Peterli  1 , Robert E Steinert, Bettina Woelnerhanssen, Thomas Peters, Caroline Christoffel-Courtin, Markus Gass, Beatrice Kern, Markus von Fluee, Christoph Beglinger
Affiliations
Randomized Controlled Trial

Metabolic and hormonal changes after laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy: a randomized, prospective trial

Ralph Peterli et al. Obes Surg. 2012 May.

Abstract

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.

Trial registration: ClinicalTrials.gov NCT00356213.

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Figures

Fig. 1
Fig. 1
HOMA index in the two groups of patients (LRYGB and LSG) before, as well as 1 week and 3 and 12 months after the respective operation. Data are means±SEM
Fig. 2
Fig. 2
Fasting and meal-stimulated time courses of glucose and insulin in two groups of patients (LRYGB and LSG) before, as well as 1 week and 3 and 12 months after the respective operation. a Glucose in the LRYGB group, b insulin in the LRYGB group, c glucose in the LSG group, d insulin in the LSG group. Data are means ± SEM
Fig. 3
Fig. 3
Fasting and meal-stimulated time courses of ghrelin and CCK in the two groups of patients (LRYGB and LSG) before, as well as 1 week and 3 and 12 months after the respective operation. a Ghrelin in the LRYGB group, b CCK in the LRYGB group, c ghrelin in the LSG group, d CCK in the LSG group. Data are means ± SEM. Details on the statistical analysis are given in Table 3
Fig. 4
Fig. 4
Fasting and meal-stimulated time courses of GLP-1 and PYY in the two groups of patients (LRYGB and LSG) before, as well as 1 week and 3 and 12 months after the respective operation. a GLP-1 in the LRYGB group, b PYY in the LRYGB group, c GLP-1 in the LSG group, d PYY in the LSG group. Data are means ± SEM. Details on the statistical analysis are given in Table 3
See this image and copyright information in PMC

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