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Lower Ghrelin Levels and Exaggerated Postprandial Peptide-YY, Glucagon-Like Peptide-1, and Insulin Responses, After Gastric Fundus Resection, in Patients Undergoing Roux-en-Y Gastric Bypass: A Randomized Clinical Trial

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An Erratum to this article was published on 13 December 2012

Abstract

Background

Laparoscopic Roux-en Y-Gastric bypass (LRYGBP) is the commonest available option for the surgical treatment of morbid obesity. Weight loss following bariatric surgery has been linked to changes of gastrointestinal peptides, shown to be implicated also in metabolic effects and appetite control. The purpose of this study was to evaluate whether gastric fundus resection in patients undergoing LRYGBP enhances the efficacy of the procedure in terms of weight loss, glucose levels, and hormonal secretion.

Methods

Twelve patients underwent LRYGBP and 12 patients LRYGBP plus gastric fundus resection (LRYGBP+FR). All patients were evaluated before and at 3, 6, and 12 months postoperatively. Blood samples were collected after an overnight fast and 30, 60, and 120 min after a standard 300-kcal mixed meal.

Results

Body weight and body mass index decreased markedly and comparably after both procedures. Fasting ghrelin decreased 3 months after LRYGBP, but increased at 12 months to levels higher than baseline while after LRYGBP+FR was markedly and persistently decreased. Postprandial GLP-1, PYY, and insulin responses were enhanced more and postprandial glucose levels were lower after LRYGBP+FR compared to LRYGBP. Postoperatively, ghrelin changes correlated negatively with GLP-1 changes.

Conclusions

Resection of the gastric fundus in patients undergoing LRYGBP was associated with persistently lower fasting ghrelin levels; higher postprandial PYY, GLP-1, and insulin responses; and lower postprandial glucose levels compared to LRYGBP. These findings suggest that fundus resection in the setting of LRYGBP may be more effective than RYGBP for the management of morbid obesity and diabetes type 2.

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Disclosures

Aikaterini Chronaiou declares no conflict of interest

Marina Tsoli declares no conflict of interest

Ioannis Kehagias declares no conflict of interest

Michalis Leotsinidis declares no conflict of interest

Fotis Kalfarentzos declares no conflict of interest

Theodore K. Alexandrides declares no conflict of interest

Author information

Authors and Affiliations

  1. Department of Surgery, School of Medicine, University of Patras, Patras, Greece

    Marina Tsoli, Ioannis Kehagias & Fotis Kalfarentzos

  2. Nutrition Support and Morbid Obesity Unit, Department of Surgery, School of Medicine, University of Patras, Patras, Greece

    Fotis Kalfarentzos

  3. Division of Endocrinology, Department of Internal Medicine, School of Medicine, University of Patras, Patras, Greece

    Aikaterini Chronaiou & Theodore K. Alexandrides

  4. Department of Laboratory of Public Health, School of Medicine, University of Patras, Patras, Greece

    Michalis Leotsinidis

  5. Division of Endocrinology, Department of Internal Medicine, School of Medicine, Rion University Hospital, University of Patras, 26500, Patras, Greece

    Theodore K. Alexandrides

Authors
  1. Aikaterini Chronaiou
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  2. Marina Tsoli
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  3. Ioannis Kehagias
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  4. Michalis Leotsinidis
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  6. Theodore K. Alexandrides
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Correspondence to Theodore K. Alexandrides.

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Chronaiou, A., Tsoli, M., Kehagias, I. et al. Lower Ghrelin Levels and Exaggerated Postprandial Peptide-YY, Glucagon-Like Peptide-1, and Insulin Responses, After Gastric Fundus Resection, in Patients Undergoing Roux-en-Y Gastric Bypass: A Randomized Clinical Trial. OBES SURG 22, 1761–1770 (2012). https://doi.org/10.1007/s11695-012-0738-5

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