Duodenal-jejunal bypass liner implantation provokes rapid weight loss and improved glycemic control, accompanied by elevated fasting ghrelin levels
Background and study aims: Endoscopic implantation of a duodenal-jejunal bypass liner (DJBL) is a novel bariatric technique to induce weight loss and remission of type 2 diabetes mellitus. Placement of the DJBL mimics the bypass component of the Roux-en-Y gastric bypass (RYGB) procedure. In this obs...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Georg Thieme Verlag KG
2014-03-01
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| Series: | Endoscopy International Open |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0034-1365222 |
| _version_ | 1811323899245232128 |
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| author | Parweez Koehestanie Kemal Dogan Frits Berends Ignace Janssen Peter Wahab Marcel Groenen Michael Müller Nicole de Wit |
| author_facet | Parweez Koehestanie Kemal Dogan Frits Berends Ignace Janssen Peter Wahab Marcel Groenen Michael Müller Nicole de Wit |
| author_sort | Parweez Koehestanie |
| collection | DOAJ |
| description | Background and study aims: Endoscopic implantation of a duodenal-jejunal bypass liner (DJBL) is a novel bariatric technique to induce weight loss and remission of type 2 diabetes mellitus. Placement of the DJBL mimics the bypass component of the Roux-en-Y gastric bypass (RYGB) procedure. In this observational study, we evaluated improvement of glycemic control and weight loss in the course of the treatment (0 – 24 weeks after DJBL implantation) and analyzed accompanying gut hormone responses.
Patients and methods: 12 obese individuals with type 2 diabetes were selected for DJBL implantation. Body weight, fat mass, and fasting plasma levels of glucose, insulin, C-peptide, and glycated hemoglobin (HbA1c), were analyzed at 0, 1, 4 and 24 weeks post-implant. Fasting ghrelin, gastric inhibitory peptide (GIP), and glucagon-like peptide (GLP-1) were determined at 0, 1 and 4 weeks post-implant.
Results: Besides significant weight loss, fat mass, fasting insulin, and homeostasis model assessment-estimated insulin resistance (HOMA-IR) index were also significantly decreased after DJBL implantation and a 42 % reduction was found in diabetes medication (P < 0.05). The fasting GLP-1 response in the first 4 weeks post-implant was significantly correlated with the fasting insulin and HOMA-IR response. Fasting ghrelin was found to be significantly elevated, in contrast to the decrease in ghrelin that is found after RYGB surgery.
Conclusions: DJBL implantation provoked significant weight loss, a decrease in fat mass, and an early remission of type 2 diabetes, comparable to results seen after RYGB surgery. Gut hormone analyses revealed a potential role of fasting GLP-1 in early remission of type 2 diabetes. Interestingly, the DJBL-induced elevation of ghrelin contradicts the suggested role of reduced ghrelin levels after RYGB in improvement of glycemic control. |
| first_indexed | 2024-04-13T14:03:39Z |
| format | Article |
| id | doaj.art-ccd2c146b4704d32b982a93e716c866e |
| institution | Directory Open Access Journal |
| issn | 2364-3722 2196-9736 |
| language | English |
| last_indexed | 2024-04-13T14:03:39Z |
| publishDate | 2014-03-01 |
| publisher | Georg Thieme Verlag KG |
| record_format | Article |
| series | Endoscopy International Open |
| spelling | doaj.art-ccd2c146b4704d32b982a93e716c866e2022-12-22T02:43:59ZengGeorg Thieme Verlag KGEndoscopy International Open2364-37222196-97362014-03-010201E21E2710.1055/s-0034-1365222Duodenal-jejunal bypass liner implantation provokes rapid weight loss and improved glycemic control, accompanied by elevated fasting ghrelin levelsParweez Koehestanie0Kemal Dogan1Frits Berends2Ignace Janssen3Peter Wahab4Marcel Groenen5Michael Müller6Nicole de Wit7Department of General Surgery, Rijnstate, Arnhem, The NetherlandsDepartment of General Surgery, Rijnstate, Arnhem, The NetherlandsDepartment of General Surgery, Rijnstate, Arnhem, The NetherlandsDepartment of General Surgery, Rijnstate, Arnhem, The NetherlandsDepartment of Gastroenterology, Rijnstate, Arnhem, The NetherlandsDepartment of Gastroenterology, Rijnstate, Arnhem, The NetherlandsDivision of Human Nutrition, Wageningen University, Wageningen, The NetherlandsDivision of Human Nutrition, Wageningen University, Wageningen, The NetherlandsBackground and study aims: Endoscopic implantation of a duodenal-jejunal bypass liner (DJBL) is a novel bariatric technique to induce weight loss and remission of type 2 diabetes mellitus. Placement of the DJBL mimics the bypass component of the Roux-en-Y gastric bypass (RYGB) procedure. In this observational study, we evaluated improvement of glycemic control and weight loss in the course of the treatment (0 – 24 weeks after DJBL implantation) and analyzed accompanying gut hormone responses. Patients and methods: 12 obese individuals with type 2 diabetes were selected for DJBL implantation. Body weight, fat mass, and fasting plasma levels of glucose, insulin, C-peptide, and glycated hemoglobin (HbA1c), were analyzed at 0, 1, 4 and 24 weeks post-implant. Fasting ghrelin, gastric inhibitory peptide (GIP), and glucagon-like peptide (GLP-1) were determined at 0, 1 and 4 weeks post-implant. Results: Besides significant weight loss, fat mass, fasting insulin, and homeostasis model assessment-estimated insulin resistance (HOMA-IR) index were also significantly decreased after DJBL implantation and a 42 % reduction was found in diabetes medication (P < 0.05). The fasting GLP-1 response in the first 4 weeks post-implant was significantly correlated with the fasting insulin and HOMA-IR response. Fasting ghrelin was found to be significantly elevated, in contrast to the decrease in ghrelin that is found after RYGB surgery. Conclusions: DJBL implantation provoked significant weight loss, a decrease in fat mass, and an early remission of type 2 diabetes, comparable to results seen after RYGB surgery. Gut hormone analyses revealed a potential role of fasting GLP-1 in early remission of type 2 diabetes. Interestingly, the DJBL-induced elevation of ghrelin contradicts the suggested role of reduced ghrelin levels after RYGB in improvement of glycemic control.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0034-1365222 |
| spellingShingle | Parweez Koehestanie Kemal Dogan Frits Berends Ignace Janssen Peter Wahab Marcel Groenen Michael Müller Nicole de Wit Duodenal-jejunal bypass liner implantation provokes rapid weight loss and improved glycemic control, accompanied by elevated fasting ghrelin levels Endoscopy International Open |
| title | Duodenal-jejunal bypass liner implantation provokes rapid weight loss and improved glycemic control, accompanied by elevated fasting ghrelin levels |
| title_full | Duodenal-jejunal bypass liner implantation provokes rapid weight loss and improved glycemic control, accompanied by elevated fasting ghrelin levels |
| title_fullStr | Duodenal-jejunal bypass liner implantation provokes rapid weight loss and improved glycemic control, accompanied by elevated fasting ghrelin levels |
| title_full_unstemmed | Duodenal-jejunal bypass liner implantation provokes rapid weight loss and improved glycemic control, accompanied by elevated fasting ghrelin levels |
| title_short | Duodenal-jejunal bypass liner implantation provokes rapid weight loss and improved glycemic control, accompanied by elevated fasting ghrelin levels |
| title_sort | duodenal jejunal bypass liner implantation provokes rapid weight loss and improved glycemic control accompanied by elevated fasting ghrelin levels |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0034-1365222 |
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