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Proximal Jejunal Bypass Improves the Outcome of Gastric Clip in Patients with Obesity and Type 2 Diabetes Mellitus

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Abstract

Background

Laparoscopic gastric clip (GC), a novel pure restrictive procedure, is a safe and effective treatment for morbid obesity. However, whether adding a proximal jejunal bypass (PJB) to this procedure might increase the efficacy is unknown.

Methods

Outcomes of 74 (43 women and 31male) obese patients who had undergone PJB-GC (41) or GC (33) for the treatment of type 2 diabetes mellitus (T2D) with 1 year follow-up were assessed. GC consists of creating a transverse gastric partition with a metallic clip. PJB consists of a jejuno-ileostomy between 20 and 320 cm distal to the ligament of Treitz. Postoperative body mass index (BMI) reduction, total weight loss (TWL), and remission rates of T2D were evaluated.

Results

The preoperative clinical characters in both groups were similar. The mean operative time was significantly longer in the PJB-GC group than in the GC group. At 24 months after surgery, the BMI was lower (32.5 ± 6.2 vs. 37.0 ± 5.9 kg/m2, p = 0.002) and weight loss higher in PJB-GC than GC (TWL 31.3 ± 14.8 vs. 23.5 ± 10.4%, p = 0.011). Remission of T2D was greater in the PJB-GC group (90.2 vs. 57.2%; p < 0.001).

Conclusions

In this study, PJB-GC was superior to GC in weight loss and T2D remission at 1 and 2 years after surgery. Adding PJB to GC increased the effect of weight loss and diabetic control.

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Authors and Affiliations

  1. Department of Bariatric and Metabolic Surgery, Jen-Ai Hospital, No. 483, Dongrong Rd., Dali Dist., Taichung City 412, Taiwan, Republic of China

    Seh-Huang Chao & Chia-Lin Lin

  2. Department of Surgery, Central Clinic Hospital, Taipei, Taiwan

    Seh-Huang Chao, Jung-Chien Chen & Ju Jun Chou

  3. Department of Surgery, Min-Sheng General Hospital, No. 168, Chin Kuo Road, Taoyuan, Taiwan, Republic of China

    Wei-Jei Lee & Jung-Chien Chen

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  1. Seh-Huang Chao
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  2. Chia-Lin Lin
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  4. Jung-Chien Chen
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  5. Ju Jun Chou
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Correspondence to Seh-Huang Chao or Wei-Jei Lee.

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Author 1 is the inventor and owner of gastric clip. The other authors have no conflicts of interest to declare.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Chao, SH., Lin, CL., Lee, WJ. et al. Proximal Jejunal Bypass Improves the Outcome of Gastric Clip in Patients with Obesity and Type 2 Diabetes Mellitus. OBES SURG 29, 1148–1153 (2019). https://doi.org/10.1007/s11695-018-3607-z

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  • DOI: https://doi.org/10.1007/s11695-018-3607-z

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