Surgical Endoscopy

, Volume 29, Issue 3, pp 723–733

The effect of duodenojejunostomy and sleeve gastrectomy on type 2 diabetes mellitus and gastrin secretion in Goto-Kakizaki rats

Authors

    • Department of Cancer Research and Molecular Medicine, Faculty of MedicineNorwegian University of Science and Technology (NTNU)
  • Ingerid Brænne Arbo
    • Department of Circulation and Medical Imaging, Faculty of MedicineNorwegian University of Science and Technology (NTNU)
  • Ole Kristian Forstrønen Thu
    • Department of Cancer Research and Molecular Medicine, Faculty of MedicineNorwegian University of Science and Technology (NTNU)
  • Esther Kuhry
    • Department of Cancer Research and Molecular Medicine, Faculty of MedicineNorwegian University of Science and Technology (NTNU)
    • Department of Gastrointestinal SurgerySt. Olavs Hospital, Trondheim University Hospital
    • National Center for Advanced Laparoscopic Surgery (NSALK)St. Olavs Hospital, Trondheim University Hospital
  • Bård Kulseng
    • Department of Cancer Research and Molecular Medicine, Faculty of MedicineNorwegian University of Science and Technology (NTNU)
    • Regional Center for Morbid Obesity (RSSO)St. Olavs Hospital, Trondheim University Hospital
  • Ronald Mårvik
    • Department of Cancer Research and Molecular Medicine, Faculty of MedicineNorwegian University of Science and Technology (NTNU)
    • Department of Gastrointestinal SurgerySt. Olavs Hospital, Trondheim University Hospital
    • Regional Center for Morbid Obesity (RSSO)St. Olavs Hospital, Trondheim University Hospital
    • National Center for Advanced Laparoscopic Surgery (NSALK)St. Olavs Hospital, Trondheim University Hospital
Article

DOI: 10.1007/s00464-014-3732-2

Cite this article as:
Grong, E., Arbo, I.B., Thu, O.K.F. et al. Surg Endosc (2015) 29: 723. doi:10.1007/s00464-014-3732-2

Abstract

Background

Bariatric surgery is a highly effective treatment of type 2 diabetes in patients with morbid obesity. The weight-loss independent improvement of glycemic control observed after these procedures has led to the discussion whether bariatric surgery can be introduced as treatment for type 2 diabetes in patients with a body mass index < 35 kg/m2. We have studied the effects of two bariatric procedures on type 2 diabetes and on gastrointestinal hormone secretion in a lean diabetic animal model.

Methods

Male Goto-Kakizaki rats, 17–18 weeks old, were randomized into three groups: duodenojejunostomy (DJ), sleeve gastrectomy (SG), or sham operation. During 36 postoperative weeks we evaluated body weight, fasting blood glucose, glucose tolerance, insulin, HbA1c, glucagon-like peptide 1, cholesterol parameters, triglycerides, total ghrelin, and gastrin.

Results

Oral glucose tolerance was significantly improved for both DJ and SG at four weeks after surgery (p < 0.05). At the 34th postoperative week, SG had significantly lower area under the curve during oral glucose tolerance test compared to sham (p = 0.007). SG had significantly lower HbA1c compared to sham at 12 weeks; (mean ± SEM) 4.3 ± 0.1 % versus 5.2 ± 0.3 % (p < 0.05) and compared to both DJ and sham 34 weeks after surgery [median (75 %;25 %)] 5.2 (6.0; 4.3) % versus 7.0 (7.5; 6.7) % and 7.3 (7.6; 6.7)  % (p = 0.009). Serum gastrin levels were markedly elevated for SG compared to DJ and sham; 188.0 (318.0; 121.0) versus 77.5 (114.0; 58.0) and 68.0 (90.0; 59.5) pmol/L (p = 0.004) at six weeks and 192.0 (587.8; 110.8) versus 65.5 (77.0; 59.0) and 69.5 (113.0; 55.5) (p = 0.001) 36 weeks after surgery.

Conclusion

Sleeve gastrectomy induces hypergastrinemia, lowers HbA1c, and improves glycemic control in Goto-Kakizaki rats. Sleeve gastrectomy is superior to duodenojejunostomy as treatment of type 2 diabetes mellitus in this animal model.

Keywords

DuodenojejunostomySleeve gastrectomyType 2 diabetes mellitusGastrinGlucagon-like peptide 1Goto-Kakizaki rat

Copyright information

© Springer Science+Business Media New York 2014