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Effect and Mechanisms of Diabetes Resolution According to the Range of Gastric Resection and the Length of Anastomosis in Animal Models: Implication for Gastric Cancer Surgery in Patients with Diabetes Mellitus

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Abstract

Background

To examine the effect and mechanism of Roux-en-Y gastric bypass (RYGB) on the improvement of diabetes according to the length of anastomosis and the gastric pouch volume in an animal model.

Methods

Glucose intolerance was induced with a high-fat diet for 3 months in Sprague–Dawley rats. The animals were subjected to conventional RYGB (cRYGB; 5% gastric pouch with 15-cm Roux limb, 40-cm biliopancreatic limb; n = 9), short-limb RYGB (sRYGB; 5%, 8, 4 cm; n = 9), fundus-sparing RYGB (fRYGB; 30%, 8, 4 cm; n = 9), or sham operation (n = 9). After 6 weeks, oral glucose tolerance tests (OGTTs) were performed, and gut hormones including insulin, total GLP-1, GIP, and ghrelin were analyzed.

Results

The cRYGB group showed significantly decreased food intake, body weight, and random glucose (p < 0.05). sRYGB resulted in a similar change of body weight loss to that of cRYGB, but with no improvement of hyperglycemia. The fRYGB group showed similar changes of body weight and random glucose to those of the sham group. In cRYGB and sRYGB, the level of insulin steeply increased until 30 min during OGTT. GLP-1 was higher at 30 min in cRYGB than in other groups, without significance. The fRYGB group showed a slowly increasing pattern in OGTT and GLP-1, and the lowest peak point in insulin and GIP.

Conclusion

cRYGB with 95% gastric resection was needed to achieve not only weight loss but also diabetes improvement, which could be related to the increase in GLP-1.

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Acknowledgements

This research was supported by grants from the Seoul National University Hospital (Grant No. 0420150340), JW-Pharmaceutical (Grant No. 0620130910), and the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (Grant No. H I14C1277).

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Author notes

  1. Yeon-Ju Huh and Young-Gil Son have contributed equally to this work.

Authors and Affiliations

  1. Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehang-ro, Jongno-gu, Seoul, 110-744, Korea

    Yeon-Ju Huh, Young-Gil Son, Tae-Han Kim, Ji-Ho Park, Han-Kwang Yang & Hyuk-Joon Lee

  2. Cancer Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehang-ro, Jongno-gu, Seoul, Korea

    Boram Choi, Jimin Min, Han-Kwang Yang & Hyuk-Joon Lee

  3. Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehang-ro, Jongno-gu, Seoul, Korea

    Tae-Jung Oh & Young Min Cho

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  1. Yeon-Ju Huh
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Correspondence to Hyuk-Joon Lee.

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Huh, YJ., Son, YG., Kim, TH. et al. Effect and Mechanisms of Diabetes Resolution According to the Range of Gastric Resection and the Length of Anastomosis in Animal Models: Implication for Gastric Cancer Surgery in Patients with Diabetes Mellitus. World J Surg 42, 1056–1064 (2018). https://doi.org/10.1007/s00268-017-4228-8

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  • DOI: https://doi.org/10.1007/s00268-017-4228-8

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