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Efficacy of Sleeve Gastrectomy with Duodenal-Jejunal Bypass for the Treatment of Obese Severe Diabetes Patients in Japan: a Retrospective Multicenter Study

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Abstract

Background

The incidence of obesity with type 2 diabetes (T2DM) is increasing in Japan. The main bariatric surgery procedures in Japan are laparoscopic sleeve gastrectomy (LSG) and LSG with duodenal-jejunal bypass (LSG/DJB) because of the high incidence of gastric cancer and difficulty exploring a remnant stomach after gastric bypass. However, few studies have compared the antidiabetic effect of LSG/DJB with LSG alone.

Purpose

The purpose of this study is to compare the antidiabetic effect of LSG/DJB with that of LSG alone in Japanese obese diabetic patients.

Methods

This was a retrospective multicenter study including 298 cases: 177 and 121 LSG and LSG/DJB cases, respectively. We investigated the antidiabetic effect of these two procedures at 12 months after surgery. Univariate and multivariate analyses were done to evaluate the predictive factors of T2DM remission.

Results

The diabetes remission rate at 12 months after surgery was 80.8% for LSG and 86.0% for LSG/DJB. Insulin use and HbA1c ≤ 6.7% were significant predictive factors in multivariate analysis for all patients. In patients with ABCD score ≥ 6, the diabetes remission rate was 94.8% and there was no difference between procedures. Only duration of diabetes and insulin use were significant predictive factors both in univariate and multivariate analyses. However, in cases with ABCD score ≤ 5, the remission rate was 70.3% and procedure type was the most significant predictive factor for diabetes remission (odds ratio [OR] 5.140).

Conclusions

Although both LSG and LSG/DJB have good antidiabetic effects in Japanese obese patients, LSG/DJB is more effective for patients with lower ABCD scores.

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Acknowledgements

We gratefully acknowledge the work of past and present members of each institution for collecting patient data and supporting surgery or patient care.

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Authors and Affiliations

  1. Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan

    Takeshi Naitoh, Hirofumi Imoto, Naoki Tanaka & Michiaki Unno

  2. Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan

    Kazunori Kasama & Yosuke Seki

  3. Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan

    Masayuki Ohta

  4. Department of Surgery, Sakura Hospital, Toho University Medical Center, Sakura, Japan

    Takashi Oshiro

  5. Department of Surgery, Iwate Medical University School of Medicine, Morioka, Japan

    Akira Sasaki

  6. Department of Surgery, Osaka University Graduate School of Medicine, Osaka, Japan

    Yasuhiro Miyazaki

  7. Department of Surgery, Shiga University of Medical Science, Otsu, Japan

    Tsuyoshi Yamaguchi

  8. Research Center for Frontier Medical Engineering, Chiba University, Chiba, Japan

    Hideki Hayashi

Authors
  1. Takeshi Naitoh
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  2. Kazunori Kasama
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  3. Yosuke Seki
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  4. Masayuki Ohta
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  5. Takashi Oshiro
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  6. Akira Sasaki
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  7. Yasuhiro Miyazaki
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  9. Hideki Hayashi
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  10. Hirofumi Imoto
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  12. Michiaki Unno
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Corresponding author

Correspondence to Takeshi Naitoh.

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Conflict of Interest

The authors declare that they have no conflicts of interest.

Ethical and Consent Statement

All procedures and data collection were in accordance with the ethical standards of the institutional and Japanese national research committees or the ethical standards of the Helsinki Declaration of 1975. LSG was done per usual clinical practice. Written informed consent was obtained for LSG/DJB because it is not approved by the national insurance system in Japan, and the procedure was performed with a private or institutional expense for clinical research. A consent form for retrospective data collection was not obtained, but the outline of this study was registered and released at the UMIN Clinical Trials Registry (UMIN-CTR) site (UMIN000020292), and the opportunity for patients to opt-out was guaranteed. All clinical data were anonymized to protect privacy.

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Naitoh, T., Kasama, K., Seki, Y. et al. Efficacy of Sleeve Gastrectomy with Duodenal-Jejunal Bypass for the Treatment of Obese Severe Diabetes Patients in Japan: a Retrospective Multicenter Study. OBES SURG 28, 497–505 (2018). https://doi.org/10.1007/s11695-017-2874-4

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  • DOI: https://doi.org/10.1007/s11695-017-2874-4

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