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Gut and Metabolic Hormones Changes After Endoscopic Sleeve Gastroplasty (ESG) Vs. Laparoscopic Sleeve Gastrectomy (LSG)

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Abstract

Introduction

ESG reduces gastric lumen similar to LSG and induces significant weight loss. However, the metabolic and physiological alteration after ESG is not fully understood. We aim to study the gastrointestinal hormone changes after ESG and compared it with LSG.

Methods

We conducted a prospective pilot study comparing ESG and LSG at two centers in Spain. We administered a standard test meal after an overnight fast, and collected blood samples before and after meal. We measured the levels of ghrelin, GLP-1, peptide-YY, insulin, leptin, and adiponectin. We evaluated the hormone profile and weight changes (%TBWL) at baseline and at 6 months after the procedure.

Results

Twenty-four patients were recruited (ESG-12, LSG-12). The baseline age, sex, BMI, and fasting hormone levels were similar between the groups. At 6-month post-ESG, there was a significant decline in the leptin levels. We found a trend towards a decrease in insulin levels and improvement in insulin secretory pattern. We did not observe any change in fasting ghrelin levels, GLP-1, and PYY. At 6 months, LSG induced a significant reduction in the ghrelin, and leptin levels, and increase in peptide-YY, and adiponectin levels, respectively. A trend towards an increase in GLP-1 level was noted. However, no change in insulin was observed. LSG achieved greater %TBWL (24.4 vs. 13.3, p < 0.001) and significantly change in ghrelin, PYY, and adiponectin levels at 6 months compared to ESG.

Conclusion

ESG induced gut hormone changes differently as compared to LSG. ESG prevented a compensatory rise in ghrelin and promoted beneficial changes in the insulin secretory pattern with weight loss.

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Abbreviations

ESG:

Endoscopic sleeve gastroplasty

LSG:

Laparoscopic sleeve gastrectomy

GLP-1:

Glucagon like peptide

PYY:

Peptide-YY

BMI:

Body mass index

AUC:

Area under concentration time curve

SD:

Standard deviation

HOMA-IR:

Homeostatic model assessment of insulin resistance

MMT:

Mixed meal test

RIA:

Radioimmunoassay

References

  1. Hussain SS, Bloom SR. The regulation of food intake by the gutbrain axis: implications for obesity. In J Obes. 2013;37:625–33.

    Article  CAS  Google Scholar 

  2. Yeo GSH, Heisler LK. Unraveling the brain regulation of appetite: lessons from genetics. Nat Neurosci. 2012;15:1343–9.

    Article  CAS  Google Scholar 

  3. Gribble FM, Reimann F. Function and mechanisms of enteroendocrine cells and gut hormones in metabolism. Nat Rev Endocrinol. 2019;15:226–37.

    Article  CAS  Google Scholar 

  4. Mishra AK, Dubey V, Ghosh AR. Obesity: an overview of possible role(s) of gut hormones, lipid sensing and gut microbiota. Metabolism. 2016;65:48–65.

    Article  CAS  Google Scholar 

  5. Kang JG, Park C-Y. Anti-obesity drugs: a review about their affects and safety. Diabetes Metab J. 2012;36:13–25.

    Article  Google Scholar 

  6. Daneschvar HL, Aronson MD, Smetana GW. FDA-approved anti-obesity drugs in the United States. Am J Med. 2016;129:879.e1–6.

    Article  Google Scholar 

  7. Srivastava G, Apovian C. Future pharmacotherapy for obesity: new anti-obesity drugs on the horizon. Curr Obes Rep. 2018;7:147–61.

    Article  Google Scholar 

  8. Maciejewski ML, Arterburn DE, Van Scoyoc L, et al. Bariatric surgery and long-term durability of weight loss. Send to. JAMA Surg. 2016;151(11):1046–55.

    Article  Google Scholar 

  9. Dimitriadis GK, Randeva MS, Miras AD. Potential hormone mechanisms of bariatric surgery. Curr Obes Rep. 2017;6:253–65.

    Article  Google Scholar 

  10. Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23:427–36.

    Article  Google Scholar 

  11. Lopez-Nava G, Sharaiha RZ, Vargas EJ, et al. Endoscopic sleeve gastroplasty for obesity: a multicenter study of 248 patients with 24 months follow-up. Obes Surg. 2017;27:2649–55.

    Article  Google Scholar 

  12. Alqahtani AR, Elahmedi M, Alqahtani YA, et al. Laparoscopic sleeve gastrectomy after endoscopic sleeve gastroplasty: technical aspects and short-term outcomes. Obes Surg. 2019;29:3547–52.

    Article  Google Scholar 

  13. Hajifathalian K et al. Long-term follow up and outcomes after endoscopic sleeve gastroplasty for treatment of obesity (5 year data). Gastrointest Endosc. 2019;89:AB58.

    Article  Google Scholar 

  14. Aminian A, Chang J, Brethauer SA, et al. ASMBS updated position statement on bariatric surgery in class I obesity (BMI 30-35 kg/m2). Surg Obes Relat Dis. 2018;14:1071–87.

    Article  Google Scholar 

  15. Grupo Colaborativo de la Sociedad Española de Nutrición Comunitaria (SENC), Aranceta Bartrina J, Arija Val V, et al. Dietary guidelines for the Spanish population (SENC, December 2016); the new graphic icon of healthy nutrition. Nutr Hosp. 2016;33:1–48.

    Google Scholar 

  16. Pruessner JC, Kirschbaum C, Meinlschmid G, et al. Two formulas for computation of the area under the curve represent measures of total hormone concentration versus time-dependent change. Psychoneuroendocrinology. 2003;28:916–31.

    Article  CAS  Google Scholar 

  17. Jirapinyo P, Thompson CC. Endoscopic bariatric and metabolic therapies: surgical analogues and mechanisms of action. Clin Gastroenterol Hepatol. 2017;15:619–30.

    Article  Google Scholar 

  18. Al Massadi O, Nogueiras R, Dieguez C, et al. Ghrelin and food reward. Neuropharmacology. 2019;148:131–8.

    Article  Google Scholar 

  19. Koliaki C, Kokkinos A, Tentolouris N, et al. The effect of ingested macronutrients on postprandial ghrelin response: a critical review of existing literature data. Int J Pept. 2010;2010:710852.

    Article  Google Scholar 

  20. Cummings DE, Weigle DS, Frayo RS, et al. Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery. N Engl J Med. 2002;346:1623–30.

    Article  Google Scholar 

  21. Svane MS, Bojsen-Møller KN, Martinussen C, et al. Postprandial nutrient handling and gastrointestinal hormone secretion after Roux-en-Y gastric bypass vs sleeve gastrectomy. Gastroenterology. 2019;156:1627–1641.e1.

    Article  Google Scholar 

  22. Abu Dayyeh BK, Acosta A, Camilleri M, et al. Endoscopic sleeve gastroplasty alters gastric physiology and induces loss of body weight in obese individuals. Clin Gastroenterol Hepatol. 2017;15:37–43.e1.

    Article  Google Scholar 

  23. Steinert RE, Feinle-Bisset C, Asarian L, et al. Ghrelin, CCK, GLP-1, and PYY(3-36): secretory controls and physiological roles in eating and glycemia in health, obesity, and after RYGB. Send to. Physiol Rev. 2017;97:411–63.

    Article  Google Scholar 

  24. McCarty TR, Jirapinyo P, Thompson CC. Effect of sleeve gastrectomy on ghrelin, GLP-1, PYY, and GIP gut hormones: a systematic review and meta-analysis. Ann Surg. 2019; https://doi.org/10.1097/SLA.0000000000003614.

  25. Yehoshua RT, Eidelman LA, Stein M, et al. Laparoscopic sleeve gastrectomy--volume and pressure assessment. Obes Surg. 2008;18:1083–8.

    Article  Google Scholar 

  26. Vargas EJ, Bazerbachi F, Calderon G, et al. Changes in time of gastric emptying after surgical and endoscopic bariatrics and weight loss: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2019; https://doi.org/10.1016/j.cgh.2019.03.047.

  27. Mallipedhi A, Prior SL, Barry JD, et al. Temporal changes in glucose homeostasis and incretin hormone response at 1 and 6 months after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2014;10:860–9.

    Article  Google Scholar 

  28. Batterham RL, Cummings DE. Mechanisms of diabetes improvement following bariatric/metabolic surgery. Diabetes Care. 2016;39:893–901.

    Article  Google Scholar 

  29. Alqahtani A, Al-Darwish A, Mahmoud AE, et al. Short-term outcomes of endoscopic sleeve gastroplasty in 1000 consecutive patients. Gastrointest Endosc. 2019;89:1132–8.

    Article  Google Scholar 

  30. Buchanan KD, McKiddie MT. The normal insulin response to glucose. The relationship between blood sugar and plasma insulin. Diabetologia. 1967;3:460–4.

    Article  CAS  Google Scholar 

  31. Pratley RE, Weyer C. The role of impaired early insulin secretion in the pathogenesis of type II diabetes mellitus. Diabetologia. 2001;44:929–45.

    Article  CAS  Google Scholar 

  32. Odegaard JI, Chawla A. Pleiotropic actions of insulin resistance and inflammation in metabolic homeostasis. Science. 2013;339:172–7.

    Article  CAS  Google Scholar 

  33. Makaronidis JM, Batterham RL. The role of gut hormones in the pathogenesis and management of obesity. Curr Opin Physiol. 2019;12:1–11.

    Article  Google Scholar 

  34. Waterson MJ, Horvath TL. Neuronal regulation of energy homeostasis: beyond the hypothalamus and feeding. Cell Metab. 2015 Dec 1;22:962–70.

    Article  CAS  Google Scholar 

  35. van der Wielen N, Paulus G, van Avesaat M, et al. Effect of endoscopic gastroplication on the genome-wide transcriptome in the upper gastrointestinal tract. Obes Surg. 2017;27:740–8.

    Article  Google Scholar 

  36. Lean MEJ, Malkova D. Altered gut and adipose tissue hormones in overweight and obese individuals: cause or consequence? Int J Obes. 2016;40:622–32.

    Article  CAS  Google Scholar 

  37. Vazquez Roque MI, Camilleri M, Stephens DA, et al. Gastric sensorimotor functions and hormone profile in normal weight, overweight, and obese people. Gastroenterology. 2006;131:1717–24.

    Article  CAS  Google Scholar 

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Author notes

  1. Gontrand Lopez-Nava and Anuradha Negi contributed equally to this work.

Authors and Affiliations

  1. Bariatric Endoscopy Unit, HM Sanchinarro University Hospital, Calle de Oña, 28050, Madrid, Spain

    Gontrand Lopez-Nava, Anuradha Negi, Inmaculada Bautista-Castaño & Ravishankar Asokkumar

  2. Department of Nutrition and Clinical Diabetes, Hospital Clinico San Carlos, Madrid, Spain

    Miguel Angel Rubio

  3. Department of Gastroenterology and Hepatology, Singapore General Hospital, Bukit Merah, Singapore

    Ravishankar Asokkumar

Authors
  1. Gontrand Lopez-Nava
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  2. Anuradha Negi
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  3. Inmaculada Bautista-Castaño
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  4. Miguel Angel Rubio
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  5. Ravishankar Asokkumar
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Contributions

GLN—conceptualized and designed the study; AN—analyzed the data and drafted the manuscript; IB—acquired the data; MAR—designed the study, performed the laboratory analysis, and collected the data; RA—analyzed the data and critically revised the manuscript.

Corresponding author

Correspondence to Ravishankar Asokkumar.

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Conflict of Interest

Dr. Gontrand Lopez Nava is a paid consultant for Apollo Endosurgery and USGI Medical, USA. All other authors have no conflict of interest.

Ethics Approval

All procedures performed in the study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The institutional review board approved the study.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Lopez-Nava, G., Negi, A., Bautista-Castaño, I. et al. Gut and Metabolic Hormones Changes After Endoscopic Sleeve Gastroplasty (ESG) Vs. Laparoscopic Sleeve Gastrectomy (LSG). OBES SURG 30, 2642–2651 (2020). https://doi.org/10.1007/s11695-020-04541-0

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  • DOI: https://doi.org/10.1007/s11695-020-04541-0

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