Experimental study of modified biliopancreatic diversion<b>-</b>duodenal transposition in rat with obese diabetes_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LU Sheng ¹ , HOU Dongsheng ² , ZHU Xiaocheng ² , YAO Libin ² , HONG Jian ² ,  SHAO Yong ²

1. Graduate School, Xuzhou Medical University, Xuzhou, Jiangsu 221004, P. R. China;
2. Department of Gastrointestinal Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, P. R. China;

Corresponding author：

SHAO Yong, Email: shaoyutong1975@163.com

Keywords：

obesity; biliopancreatic diversion with duodenal switch; gastrointestinal anastomotic position; esophageal reflux

DOI：

10.7507/1007-9424.202112017

Video：

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Objective To compare the curative effect of biliopancreatic diversion with duodenal switch (BPD/DS) with different gastrointestinal anastomotic position in the rat with obese diabetes. Methods The obese diabetic rat models were induced by high-fat feeding for 1 month combined with intraperitoneal injection of low-dose streptozotocin (35 mg/kg), then which were divided into modified BPD/DS (M-BPD/DS), BPD/DS, sleeve gastrectomy (SG), and sham operation (SO) groups according to the operation performed. Eight rats in each group were randomly selected for following experimental observation. The situation of weight loss, glucose reduction, nutrition, and esophagitis were compared among 4 groups, especially between the M-BPD/DS and BPD/DS groups. Results ① The body mass and food intake of rats in the M-BPD/DS and BPD/DS groups at 1–4 month(s) after operation (except food intake at the 4th month) were lower than those in the SO group (P<0.05), but it was found that the food intake of the M-BPD/DS group was higher than that of the BPD/DS group at the first month after operation (P<0.05). ② The fasting blood glucose levels of the M-BPD/DS and BPD/DS groups were lower than those of the SO group (P<0.05) and were lower than those before the operation (P<0.05), but which had no statistical difference between the M-BPD/DS and BPD/DS groups (P>0.05). ③ The area under receiver operating characteristic curve (AUC) of blood glucose level by oral glucose tolerance test, insulin tolerancetest (ITT), and the homeostasis model assessment-insulin resistance index at the 1st and 4th month after operation of the M-BPD/DS and BPD/DS groups were lower of the SO group (P<0.05) and before operation (P<0.05), but which had no statistical difference between the M-BPD/DS and BPD/DS groups (P>0.05). It was also found that the AUCs of ITT values at the 4th month after operation of the M-BPD/DS and BPD/DS groups were higher than those of the 1st month after operation (P<0.05). ④ The AUCs of the glucagon like peptide-1 (GLP-1) levels at the 1st and 4th month after operation of the M-BPD/DS and BPD/DS groups were higher than those of the SO group (P<0.05), while the AUCs of the insulin index were lower than those of the SO group (P<0.05) at 1 and 4 months after operation. At the 1st and 4th month after operation, the AUCs of the GLP-1 were higher and the insulin were lower than those before operation (P<0.05) in the M-BPD/DS and BPD/DS groups, which had no statistical difference between the M-BPD/DS and BPD/DS groups (P>0.05). ⑤ The albumin, calcium, and ferrum at the 1st and 4th month after operation of the M-BPD/DS and BPD/DS groups were statistically lower than those of the SO group (P<0.05) and lower than those before operation (P<0.05). ⑥ The thickness of esophageal squamous epithelium and rate of nipple elongation of the M-BPD/DS group were lower than those of the BPD/DS group (P<0.05). Conclusion The results of this experiment suggest that moving the gastrointestinal anastomosis above the pylorus simplifies the operationof BPD/DS without affecting its weight loss and glucose lowering effect , and may have a protective effect on the esophagus.

Citation： LU Sheng, HOU Dongsheng, ZHU Xiaocheng, YAO Libin, HONG Jian, SHAO Yong. Experimental study of modified biliopancreatic diversion-duodenal transposition in rat with obese diabetes. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(9): 1181-1188. doi: 10.7507/1007-9424.202112017 Copy

1.	Finkelstein EA, Khavjou OA, Thompson H, et al. Obesity and severe obesity forecasts through 2030. Am J Prev Med, 2012, 42(6): 563-570.
2.	Ward ZJ, Bleich SN, Cradock AL, et al. Projected U. S. state-level prevalence of adult obesity and severe obesity. N Engl J Med, 2019, 381(25): 2440-2450.
3.	Sturm R, Hattori A. Morbid obesity rates continue to rise rapidly in the United States. Int J Obes (Lond), 2013, 37(6): 889-891.
4.	Ohta M, Seki Y, Wong SK, et al. Bariatric/metabolic surgery in the Asia-Pacific region: APMBSS 2018 survey. Obes Surg, 2019, 29(2): 534-541.
5.	Lauti M, Kularatna M, Hill AG, et al. Weight regain following sleeve gastrectomy—a systematic review. Obes Surg, 2016, 26(6): 1326-1334.
6.	Bakr AA, Fahmy MH, Elward AS, et al. Analysis of medium-term weight regain 5 years after laparoscopic sleeve gastrectomy. Obes Surg, 2019, 29(11): 3508-3513.
7.	Nedelcu M, Loureiro M, Skalli M, et al. Laparoscopic sleeve gastrectomy: effect on long-term remission for morbidly obese patients with type 2 diabetes at 5-year follow up. Surgery, 2017, 162(4): 857-862.
8.	Sudan R, Jain-Spangler K. Tailoring bariatric surgery: sleeve gastrectomy, Roux-en-Y gastric bypass and biliopancreatic diversion with duodenal switch. J Laparoendosc Adv Surg Tech A, 2018, 28(8): 956-961.
9.	Cosentino C, Marchetti C, Monami M, et al. Efficacy and effects of bariatric surgery in the treatment of obesity: network meta-analysis of randomized controlled trials. Nutr Metab Cardiovasc Dis, 2021, 31(10): 2815-2824.
10.	Kapeluto JE, Tchernof A, Masckauchan D, et al. Ten-year remission rates in insulin-treated type 2 diabetes after biliopancreatic diversion with duodenal switch. Surg Obes Relat Dis, 2020, 16(11): 1701-1712.
11.	Nett P, Borbély Y, Kröll D. Micronutrient supplementation after biliopancreatic diversion with duodenal switch in the long term. Obes Surg, 2016, 26(10): 2469-2474.
12.	Strain GW, Torghabeh MH, Gagner M, et al. The impact of biliopancreatic diversion with duodenal switch (BPD/DS) over 9 years. Obes Surg, 2017, 27(3): 787-794.
13.	Roth AE, Thornley CJ, Blackstone RP. Outcomes in bariatric and metabolic surgery: an updated 5-year review. Curr Obes Rep, 2020, 9(3): 380-389.
14.	Merz AE, Blackstone RB, Gagner M, et al. Duodenal switch in revisional bariatric surgery: conclusions from an expert consensus panel. Surg Obes Relat Dis, 2019, 15(6): 894-899.
15.	Yashkov Y, Bordan N, Torres A, et al. SADI-S 250 vs Roux-en-Y duodenal switch (RY-DS): results of 5-year observational study. Obes Surg, 2021, 31(2): 570-579.
16.	Lebel S, Dion G, Marceau S, et al. Clinical outcomes of duodenal switch with a 200-cm common channel: a matched, controlled trial. Surg Obes Relat Dis, 2016, 12(5): 1014-1020.
17.	Zhang M, Lv XY, Li J, et al. The characterization of high-fat diet and multiple low-dose streptozotocin induced type 2 diabetes rat model. Exp Diabetes Res, 2008, 2008: 704045. doi: 10.1155/2008/704045.
18.	Liu P, Widjaja J, Dolo PR, et al. Comparing the anti-diabetic effect of sleeve gastrectomy with transit bipartition against sleeve gastrectomy and Roux-en-Y gastric bypass using a diabetic rodent model. Obes Surg, 2021, 31(5): 2203-2210.
19.	Biertho L, Lebel S, Marceau S, et al. Biliopancreatic diversion with duodenal switch: surgical technique and perioperative care. Surg Clin North Am, 2016, 96(4): 815-826.
20.	Hutch CR, Sandoval D. The role of GLP-1 in the metabolic success of bariatric surgery. Endocrinology, 2017, 158(12): 4139-4151.
21.	Sandoval D. CNS GLP-1 regulation of peripheral glucose homeostasis. Physiol Behav, 2008, 94(5): 670-674.
22.	Ramos-Leví AM, Sánchez-Pernaute A, Marcuello C, et al. Glucose variability after bariatric surgery: is prediction of diabetes remission possible? Obes Surg, 2017, 27(12): 3341-3343.
23.	Santoro S, Mota FC, Aquino CG. Treating severe GERD and obesity with a sleeve gastrectomy with cardioplication and a transit bipartition. Obes Surg, 2019, 29(4): 1439-1441.
24.	Santoro S, Lacombe A, Aquino CG, et al. Sleeve gastrectomy with anti-reflux procedures. Einstein (Sao Paulo), 2014, 12(3): 287-294.
25.	Vieth M, Peitz U, Labenz J, et al. What parameters are relevant for the histological diagnosis of gastroesophageal reflux disease without Barrett’s mucosa? Dig Dis, 2004, 22(2): 196-201.
26.	Ismail-Beigi F, Horton PF, Pope CE 2nd. Histological consequences of gastroesophageal reflux in man. Gastroenterology, 1970, 58(2): 163-174.
27.	Guimarães AGC, Lopes LES, Capelassi AN, et al. Morphological alterations in gastrointestinal organs of western-diet obese rats submitted to vertical sleeve gastrectomy or Roux-en-Y gastric bypass. An Acad Bras Cienc, 2021, 93（4）: e20200884. doi: 10.1590/0001-3765202120200884.
28.	van Beek AP, Emous M, Laville M, et al. Dumping syndrome after esophageal, gastric or bariatric surgery: pathophysiology, diagnosis, and management. Obes Rev, 2017, 18(1): 68-85.
29.	Santoro S, Castro LC, Velhote MC, et al. Sleeve gastrectomy with transit bipartition: a potent intervention for metabolic syndrome and obesity. Ann Surg, 2012, 256(1): 104-110.
30.	Rodrigo DC, Jill S, Daniel M, et al. Which factors correlate with marginal ulcer after surgery for obesity? Obes Surg, 2020, 30(12): 4821-4827.
31.	Mahdy T, Al Wahedi A, Schou C. Efficacy of single anastomosis sleeve ileal (SASI) bypass for type-2 diabetic morbid obese patients: gastric bipartition, a novel metabolic surgery procedure: a retrospective cohort study. Int J Surg, 2016, 34: 28-34.

1. Finkelstein EA, Khavjou OA, Thompson H, et al. Obesity and severe obesity forecasts through 2030. Am J Prev Med, 2012, 42(6): 563-570.
2. Ward ZJ, Bleich SN, Cradock AL, et al. Projected U. S. state-level prevalence of adult obesity and severe obesity. N Engl J Med, 2019, 381(25): 2440-2450.
3. Sturm R, Hattori A. Morbid obesity rates continue to rise rapidly in the United States. Int J Obes (Lond), 2013, 37(6): 889-891.
4. Ohta M, Seki Y, Wong SK, et al. Bariatric/metabolic surgery in the Asia-Pacific region: APMBSS 2018 survey. Obes Surg, 2019, 29(2): 534-541.
5. Lauti M, Kularatna M, Hill AG, et al. Weight regain following sleeve gastrectomy—a systematic review. Obes Surg, 2016, 26(6): 1326-1334.
6. Bakr AA, Fahmy MH, Elward AS, et al. Analysis of medium-term weight regain 5 years after laparoscopic sleeve gastrectomy. Obes Surg, 2019, 29(11): 3508-3513.
7. Nedelcu M, Loureiro M, Skalli M, et al. Laparoscopic sleeve gastrectomy: effect on long-term remission for morbidly obese patients with type 2 diabetes at 5-year follow up. Surgery, 2017, 162(4): 857-862.
8. Sudan R, Jain-Spangler K. Tailoring bariatric surgery: sleeve gastrectomy, Roux-en-Y gastric bypass and biliopancreatic diversion with duodenal switch. J Laparoendosc Adv Surg Tech A, 2018, 28(8): 956-961.
9. Cosentino C, Marchetti C, Monami M, et al. Efficacy and effects of bariatric surgery in the treatment of obesity: network meta-analysis of randomized controlled trials. Nutr Metab Cardiovasc Dis, 2021, 31(10): 2815-2824.
10. Kapeluto JE, Tchernof A, Masckauchan D, et al. Ten-year remission rates in insulin-treated type 2 diabetes after biliopancreatic diversion with duodenal switch. Surg Obes Relat Dis, 2020, 16(11): 1701-1712.
11. Nett P, Borbély Y, Kröll D. Micronutrient supplementation after biliopancreatic diversion with duodenal switch in the long term. Obes Surg, 2016, 26(10): 2469-2474.
12. Strain GW, Torghabeh MH, Gagner M, et al. The impact of biliopancreatic diversion with duodenal switch (BPD/DS) over 9 years. Obes Surg, 2017, 27(3): 787-794.
13. Roth AE, Thornley CJ, Blackstone RP. Outcomes in bariatric and metabolic surgery: an updated 5-year review. Curr Obes Rep, 2020, 9(3): 380-389.
14. Merz AE, Blackstone RB, Gagner M, et al. Duodenal switch in revisional bariatric surgery: conclusions from an expert consensus panel. Surg Obes Relat Dis, 2019, 15(6): 894-899.
15. Yashkov Y, Bordan N, Torres A, et al. SADI-S 250 vs Roux-en-Y duodenal switch (RY-DS): results of 5-year observational study. Obes Surg, 2021, 31(2): 570-579.
16. Lebel S, Dion G, Marceau S, et al. Clinical outcomes of duodenal switch with a 200-cm common channel: a matched, controlled trial. Surg Obes Relat Dis, 2016, 12(5): 1014-1020.
17. Zhang M, Lv XY, Li J, et al. The characterization of high-fat diet and multiple low-dose streptozotocin induced type 2 diabetes rat model. Exp Diabetes Res, 2008, 2008: 704045. doi: 10.1155/2008/704045.
18. Liu P, Widjaja J, Dolo PR, et al. Comparing the anti-diabetic effect of sleeve gastrectomy with transit bipartition against sleeve gastrectomy and Roux-en-Y gastric bypass using a diabetic rodent model. Obes Surg, 2021, 31(5): 2203-2210.
19. Biertho L, Lebel S, Marceau S, et al. Biliopancreatic diversion with duodenal switch: surgical technique and perioperative care. Surg Clin North Am, 2016, 96(4): 815-826.
20. Hutch CR, Sandoval D. The role of GLP-1 in the metabolic success of bariatric surgery. Endocrinology, 2017, 158(12): 4139-4151.
21. Sandoval D. CNS GLP-1 regulation of peripheral glucose homeostasis. Physiol Behav, 2008, 94(5): 670-674.
22. Ramos-Leví AM, Sánchez-Pernaute A, Marcuello C, et al. Glucose variability after bariatric surgery: is prediction of diabetes remission possible? Obes Surg, 2017, 27(12): 3341-3343.
23. Santoro S, Mota FC, Aquino CG. Treating severe GERD and obesity with a sleeve gastrectomy with cardioplication and a transit bipartition. Obes Surg, 2019, 29(4): 1439-1441.
24. Santoro S, Lacombe A, Aquino CG, et al. Sleeve gastrectomy with anti-reflux procedures. Einstein (Sao Paulo), 2014, 12(3): 287-294.
25. Vieth M, Peitz U, Labenz J, et al. What parameters are relevant for the histological diagnosis of gastroesophageal reflux disease without Barrett’s mucosa? Dig Dis, 2004, 22(2): 196-201.
26. Ismail-Beigi F, Horton PF, Pope CE 2nd. Histological consequences of gastroesophageal reflux in man. Gastroenterology, 1970, 58(2): 163-174.
27. Guimarães AGC, Lopes LES, Capelassi AN, et al. Morphological alterations in gastrointestinal organs of western-diet obese rats submitted to vertical sleeve gastrectomy or Roux-en-Y gastric bypass. An Acad Bras Cienc, 2021, 93（4）: e20200884. doi: 10.1590/0001-3765202120200884.
28. van Beek AP, Emous M, Laville M, et al. Dumping syndrome after esophageal, gastric or bariatric surgery: pathophysiology, diagnosis, and management. Obes Rev, 2017, 18(1): 68-85.
29. Santoro S, Castro LC, Velhote MC, et al. Sleeve gastrectomy with transit bipartition: a potent intervention for metabolic syndrome and obesity. Ann Surg, 2012, 256(1): 104-110.
30. Rodrigo DC, Jill S, Daniel M, et al. Which factors correlate with marginal ulcer after surgery for obesity? Obes Surg, 2020, 30(12): 4821-4827.
31. Mahdy T, Al Wahedi A, Schou C. Efficacy of single anastomosis sleeve ileal (SASI) bypass for type-2 diabetic morbid obese patients: gastric bipartition, a novel metabolic surgery procedure: a retrospective cohort study. Int J Surg, 2016, 34: 28-34.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Experimental study of modified biliopancreatic diversion-duodenal transposition in rat with obese diabetes

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