Obesity Surgery

, 18:1089

The Effect of Laparoscopic Gastric Banding Surgery on Plasma Levels of Appetite-Control, Insulinotropic, and Digestive Hormones

  • Joshua R. Shak
  • Jatin Roper
  • Guillermo I. Perez-Perez
  • Chi-hong Tseng
  • Fritz Francois
  • Zoi Gamagaris
  • Carlie Patterson
  • Elizabeth Weinshel
  • George A. Fielding
  • Christine Ren
  • Martin J. Blaser
Research Article

DOI: 10.1007/s11695-008-9454-6

Cite this article as:
Shak, J.R., Roper, J., Perez-Perez, G.I. et al. OBES SURG (2008) 18: 1089. doi:10.1007/s11695-008-9454-6
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Abstract

Background

We hypothesized that laparoscopic adjustable gastric banding (LAGB) reduces weight and modulates ghrelin production, but largely spares gastrointestinal endocrine function. To examine this hypothesis, we determined plasma concentrations of appetite-control, insulinotropic, and digestive hormones in relation to LAGB.

Methods

Twenty-four patients undergoing LAGB were prospectively enrolled. Body mass index (BMI) was measured and blood samples obtained at baseline and 6 and 12 months post-surgery. Plasma concentrations of leptin, acylated and total ghrelin, pancreatic polypeptide (PP), insulin, glucose-dependent insulinotropic peptide (GIP), active glucagon-like peptide-1 (GLP-1), gastrin, and pepsinogens I and II were measured using enzyme-linked immunoassays.

Results

Median percent excess weight loss (%EWL) over 12 months was 45.7% with median BMI decreasing from 43.2 at baseline to 33.8 at 12 months post-surgery (p < 0.001). Median leptin levels decreased from 19.7 ng/ml at baseline to 6.9 ng/ml at 12 months post-surgery (p < 0.001). In contrast, plasma levels of acylated and total ghrelin, PP, insulin, GIP, GLP-1, gastrin, and pepsinogen I did not change in relation to surgery (p > 0.05). Pepsinogen II levels were significantly lower 6 months after LAGB but returned to baseline levels by 12 months.

Conclusions

LAGB yielded substantial %EWL and a proportional decrease in plasma leptin. Our results support the hypothesis that LAGB works in part by suppressing the rise in ghrelin that normally accompanies weight loss. Unchanged concentrations of insulinotropic and digestive hormones suggest that gastrointestinal endocrine function is largely maintained in the long term.

Keywords

Obesity Weight loss Bariatric surgery Adjustable gastric banding Ghrelin Leptin GIP GLP-1 

Supplementary material

11695_2008_9454_MOESM1_ESM.eps (300 kb)
Supplemental Fig. 1Ghrelin dynamics in subjects stratified by amount of weight loss after LAGB. Subjects were divided into two groups, based on their %EWL over 12 months. Group I (blue diamonds): %EWL = 14.4 to 43.2 (n = 11); Group II (green circles): %EWL = 48.1 to 62.3 (n = 11). Panels show values at baseline, 6 and 12 months for: mean BMI (a), plasma concentrations of total ghrelin (b) and acylated ghrelin (c), and the acylated/total ghrelin ratio (d). Statistical significance assessed at each time point for each variable using unpaired Wilcoxon signed rank tests, *p < 0.05 (EPS 300 kb)
11695_2008_9454_MOESM2_ESM.eps (406 kb)
Supplemental Table 1BMI and fasting serum peptide levels before and 6 and 12 month after LAGB (EPS 406 kb)
11695_2008_9454_MOESM3_ESM.eps (417 kb)
Supplemental Table 2Medium BMI and peptide concentrations by H. pylori status (EPS 417 kb)

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • Joshua R. Shak
    • 1
  • Jatin Roper
    • 1
  • Guillermo I. Perez-Perez
    • 1
  • Chi-hong Tseng
    • 2
  • Fritz Francois
    • 1
    • 5
  • Zoi Gamagaris
    • 1
    • 3
  • Carlie Patterson
    • 3
  • Elizabeth Weinshel
    • 1
    • 5
  • George A. Fielding
    • 4
  • Christine Ren
    • 4
  • Martin J. Blaser
    • 1
    • 5
  1. 1.Department of MedicineNYU School of MedicineNew YorkUSA
  2. 2.Department of MedicineUniversity of CaliforniaLos AngelesUSA
  3. 3.Department of MedicineBellevue Hospital CenterNew YorkUSA
  4. 4.Department of SurgeryNYU School of MedicineNew YorkUSA
  5. 5.VA NY Harbor Healthcare SystemNew YorkUSA

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