Skip to main content
SpringerLink
Log in

Effect of Resected Gastric Volume on Ghrelin and GLP-1 Plasma Levels: a Prospective Study

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

The correlation between resected gastric volume (RGV) and neuro-humoral changes (ghrelin and GLP-1) after laparoscopic sleeve gastrectomy (LSG) and their effects on type 2 diabetes mellitus (T2DM) has been evaluated.

Materials

Ninety-eight patients were divided in two groups: RGV <1200 mL (group A: 53 pts) and RGV >1200 mL (group B: 45 pts). Insulin secretion (insulin area under the curve (AUC)), insulinogenic index (IGI) and insulin-resistance (homeostasis model assessment, HOMAIR) were assessed before and after surgery (at the 3rd day and 6, 12 and 24 months after LSG) using the oral glucose tolerance test (OGTT). At the same time, ghrelin and GLP-1 levels were determined.

Results

A significant difference in T2DM resolution rate was observed after 6, 12 and 24 months in favour of RGV >1200 mL. Group B performed better than group A at the 3rd day and at the 6th, 12th and 24th months with regard to AUC, IGI and HOMAIR. In both groups, OGTT resulted in decreased ghrelin values and a significant increase in GLP-1 values for group B at the 3rd day and at the 6th and 12th months with no difference at the 24th month.

Conclusion

Ghrelin and GLP-1 changes play a role in the regulation of glucose metabolism during the 1st year after LSG. RGV influences ghrelin and GLP-1 plasma levels after LSG, with a significant improvement in the T2DM control.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Danaei G, Finucane MM, Lu Y, Singh GM, Cowan MJ, Paciorek CJ, Lin JK, Farzadfar F, Khang YH, Stevens GA, Rao M, Ali MK, Riley LM, Robinson CA, Ezzati M; Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (Blood Glucose). National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants. Lancet 2011; 378 (9785): 31–40.

    Article  CAS  PubMed  Google Scholar 

  2. Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ, Bantle JP, Sledge I. Weight and type 2 diabetes after bariatric surgery: systematic review and metanalysis. Am J Med 2009;122(3):248–256.e5.

    Article  PubMed  Google Scholar 

  3. Cho JM, Kim HJ Menzo El, Park S, Szomstein S, Rosenthal RJ. Effect of sleeve gastrectomy on type 2 diabetes as an alternative treatment modality to Roux-en-Y gastric bypass: systemic review and meta-analysis. Surg Obes Relat Dis. 2015 Mar 5. pii: S1550-7289(15)00056-8.

  4. Sjöström L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B, Dahlgren S, Larsson B, Narbro K, Sjöström CD, Sullivan M, Wedel H; Swedish Obese Subjects Study Scientific Group. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 2004 Dec 23;351(26):2683–93.

  5. BuchwaldH, OienDM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23(4): 427–36.

  6. Yip S, Signal M, Smith G, Beban G, Booth M, Babor R, Chase JG, Murphy R.: Lower glycemic fluctuations early after bariatric surgery partially explained by caloric restriction. Obes Surg. 2014 Jan;24(1):62–70.

  7. Plourde CE, Grenier-Larouche T, Caron-Dorval D, Biron S, Marceau S, Lebel S, Biertho L, Tchernof A, Richard D, Carpentier AC.: Bili-opancreatic diversion with duodenal switch improves insulin sensitivity and secretion through caloric restriction. Obesity (Silver Spring). 2014 Aug;22(8):1838–46.

  8. Peterli R, Wölnerhanssen B, Peters T, Devaux N, Kern B, Christoffel-Courtin C, Drewe J, von Flüe M, Beglinger C. Improvement in glucose metabolism after bariatric surgery: Comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy: A prospective randomized trial. Ann Surg. 2009 Aug;250(2):234–41.

  9. Blaire Anderson, Noah J. Switzer, Ahmad Almamar, Xinzhe Shi, Daniel W. Birch, Shahzeer Karmali: The Impact of Laparoscopic Sleeve Gastrectomy on Plasma Ghrelin Levels: a Systematic Review. Obes Surg 2013; 23(9):1476–80.

    Article  PubMed  Google Scholar 

  10. L Pawanindra, A Vindal, M Midha, P Nagpal, A Manchanda, J Chander. Early post-operative weight loss after laparoscopic sleeve gastrectomy correlates with the volume of the excised stomach and not with that of the sleeve! Preliminary data from a multi-detector computed tomography-based study. Surg Endosc (2015) 29:2921–2927

    Article  PubMed  Google Scholar 

  11. FW Obeidat, HA Shanti, AA Mismar, MS Elmuhtaseb, MS Al-Qudah. Volume of resected stomach as a predictor of excess weight loss after sleeve gastrectomy. Obes Surg. 2014 Nov. 24(11):1904–8.

  12. Sista F, Abruzzese V, Colozzi S, Schietroma M, Carlei F, Mattei A, Clementi M, Carandina S, Barrat C, Amicucci G. Does gastric resection volume influence sleeve gastrectomy results? A prospective study. Int J Surg. 2016:3(1):11–17.

    Article  Google Scholar 

  13. Basso N, Capoccia D, Rizzello M, Abbatini F, Mariani P, Maglio C, Coccia F, Borgonuovo G, De Luca ML, Asprino R, Alessandri G, Casella G, Leonetti F. First-phase insulin secretion, insulin sensitivity, ghrelin, GLP-1, and PYY changes 72 h after sleeve gastrectomy in obese diabetic patients: the gastric hypothesis. Surg Endosc 2011; 25:3540–3550.

    Article  CAS  PubMed  Google Scholar 

  14. Laville M, Disse E Bariatric surgery for diabetes treatment: why should we go rapidly to surgery. Diabetes Metab. 2009 Dec;35(6 Pt 2):562–3.

  15. Philips DIW, Clark PM, Hales CN, Osmond C: Understanding oral glucose tolerance: comparison of glucose or insulin measurements during the oral glucose tolerance test with specific measurements of insulin resistance and insulin secretion. Diabetic Med 11, 286–292, 1994

    Article  Google Scholar 

  16. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RL: Homeostasis model assessment insulin resistance and b-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28, 412–419, 1985

    Article  CAS  PubMed  Google Scholar 

  17. Nocca D, Guillaume F, Noel P, Picot MC, Aggarwal R, El Kamel M, Schaub R, de Sequin de Hons C, Renard E, Fabre JM. Impact of laparoscopic sleeve gastrectomy and laparoscopic gastric bypass on HbA1c blood level and pharmacological treatment of type 2 diabetes mellitus in severe or morbidly obese patients: results of a multicentre prospective study at 1 year. Obes Surg 2011jun;21(6):738–43.

  18. Abbatini F, Rizzello M, Casella G, Alessandri G, Capoccia D, Leonetti F, Basso N. Long-term effects of laparoscopic sleeve gastrectomy, gastric bypass, and adjustable gastric banding on type 2 diabetes. Surg Endosc. 2010 May;24(5):1005–10

  19. de Gordejuela AG, Pujol Gebelli J, García NV, Alsina EF, Medayo LS, Masdevall Noguera C. Is sleeve gastrectomy as effective as gastric bypass for remission of type 2 diabetes in morbidly obese patients? Surg Obes Relat Dis. 2011 Jul-Aug;7(4):506–9.

  20. Shah PS, Todkar JS, Shah SS. Effectiveness of laparoscopic sleeve gastrectomy on glycemic control in obese Indians with type 2 diabetes mellitus. Surg Obes Relat Dis. 2010 Mar 4;6(2):138–41

  21. Gill RS, Birch DW, Shi X, Sharma AM, Karmali S. Sleeve gastrectomy and type 2 diabetes mellitus: a systematic review. 2010 Nov-Dec;6(6):707–13

  22. Evans S, Pamuklar Z, Rosko J, Mahaney P, Jiang N, Park C, Torquati A. Gastric bypass surgery restores meal stimulation of the anorexigenic gut hormones glucagon-like peptide-1 and peptide YY independently of caloric restriction .Surg Endosc. 2012 Apr;26(4):1086–94

  23. Lee WJ, Ser KH, Chong K, Lee YC, Chen SC, Tsou JJ, Chen JC, Chen CM. Laparoscopic sleeve gastrectomy for diabetes treatment in nonmorbidly obese patients: efficacy and change of insulin secretion. Surgery. 2010 May;147(5):664–9.

  24. Vestergaard ET, Djurhuus CB, Gjedsted J, Nielsen S, Møller N, Holst JJ, Jørgensen JO, Schmitz O Acute effects of ghrelin administration on glucose and lipid metabolism. J Clin Endocrinol Meta 2008; 93(2):438–444.

    Article  CAS  Google Scholar 

  25. Pinkney JH, Sjostrom CD, Gale EA. Should surgeons treat diabetes in severely obese people? Lancet. 2001 Apr 28;357(9265):1357–9.

  26. A. Maleckas, L. Venclauskas, V. Wallenius, H. Lönroth, L. Fändriks. Surgery in the treatment of type 2 diabetes mellitus. Scand J Surg. 2015 Mar;104(1):40–7

  27. Romero F, Nicolau J, Flores L, Casamitjana R, Ibarzabal A, Lacy A, Vidal J. Comparable early changes in gastrointestinal hormones after sleeve gastrectomy and Roux-En-Y gastric bypass surgery for morbidly obese type 2 diabetic subjects. Surg Endosc. 2012 Aug;26(8):2231–9

  28. Jagat Pal Singh, Om Tantia Tamonas Chaudhuri, Shashi Khanna, Prateek H. Patil. Is Resected Stomach Volume Related to Weight Loss After Laparoscopic Sleeve Gastrectomy? Obes Surg.2014 Oct;24(10):1656–61.

  29. Firas W. Obeidat, Hiba A. Shanti, Ayman A. Mismar, M. S. Elmuhtaseb, Mohammad S. Al- Qudah Volume of Resected Stomach as a Predictor of Excess Weight Loss After Sleeve Gastrectomy. Obes Surg.2014 Nov ;24(10):1904–1908.

  30. Causey MW, Fitzpatrick E, Carter P. Pressure tolerance of newly constructed staple lines in sleeve gastrectomy and duodenal switch. Am J Surg. 2013 May;205(5):571–4; discussion 574–5.

  31. RA Weiner, S Weiner, I Pomhoff, Cjacobi W Makarewicz G Weigand. Laparoscopic sleeve gastrectomy- influence of sleeve size and resected gastric volume. Obesity Surg;17: 1297–1305.

  32. Faraj M, Lu HL, Cianflone K. Diabetes, lipids, and adipocyte secretagogues. Biochem Cell Biol. 2004 Feb;82(1):170–90.

  33. Yuval JB, Mintz Y, Cohen MJ, Rivkind AI, Elazary R. The effects of bougie caliber on leaks and excess weight loss following laparoscopic sleeve gastrectomy. Is there an ideal bougie size? Obes Surg. 2013 Oct;23(10):1685–91.

Download references

Acknowledgments

We would like to thank Professor Alessio Agnifili, who made substantial contributions to the conception and design of the study. The author considers him a mentor in the healthcare profession and in his everyday life.

Authors’ contributions

Sista F and Abruzzese V have made substantial contributions to the conception and design of the study, as well as drafting of the work and its critical revision for important intellectual content; Clementi M has made analysis and interpretation of literature data; and Carandina S and Amicucci G have given final approval of the version to be published.

Author information

Authors and Affiliations

  1. Dipartimento di Scienze Cliniche Applicate e Biotecnologie (DISCAB)—Ospedale civile San Salvatore, University of L’Aquila, L’Aquila, Italy

    Federico Sista, Valentina Abruzzese, Marco Clementi & Gianfranco Amicucci

  2. Dipartimento di Scienze Cliniche Applicate e Biotecnologie (DISCAB) - Ospedale civile San Salvatore, University of L’Aquila, Presso Ospedale S. Salvatore, Edificio Delta 6, 67100, Coppito, AQ, Italy

    Federico Sista

  3. Service de Chirurgie Digestive—Hôpital Avicenne, Université Paris XIII, Bobigny, France

    Sergio Carandina

Authors
  1. Federico Sista
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Valentina Abruzzese
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marco Clementi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sergio Carandina
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gianfranco Amicucci
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Federico Sista.

Ethics declarations

The ethical committee of the DISCAB Department of the University of L’Aquila approved the protocol of the study. All patients signed a consent form.

Financial support

None

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sista, F., Abruzzese, V., Clementi, M. et al. Effect of Resected Gastric Volume on Ghrelin and GLP-1 Plasma Levels: a Prospective Study. J Gastrointest Surg 20, 1931–1941 (2016). https://doi.org/10.1007/s11605-016-3292-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-016-3292-y

Keywords

Search

Navigation