Clinical Remission Effect Of Sleeve Gastrectomy On Type 2 Diabetes Patients And Impacts For Rat Intestinal Function And Morphology

Part one Effects of Laparoscopic Sleeve Gastrectomy versus Roux-en-Y Gastric Bypass for the Treatment of Chinese Type 2 Diabetes Mellitus Patients with body mass index 28-35kg/m2Background Obestity and Type 2 diabetes(T2D) are two of the most common metabolic disorders in the world. Both are significantly increased during the last decades. Bariatric surgery are superior to conservative therapies in managing T2 DM, and Laparoscopic Roux-en-Y bypass(RYGB) and laparoscopic vertical sleeve gastrectomy(VSG) are the most popular procedures. RYGB is the most commonly supported procedure that can cure most T2 DM in morbidly and mild obese patients. It is still controversial, however, whether SG has the same positive outcomes on T2 DM in Chinese mild obese patients as compared to RYGB. Objective To compare three-year effects of two bariatric procedures for Chinese type 2 diabetes mellitus(T2DM) patients with a body mass index(BMI) of 28-35 kg/m2. Methods 55 patients were included. 27 RYGB and 28 VSG procedures performed by the same surgical team in three hospitals with T2 D and had a history not exceeding 10 years, with C peptide over 0.8ng/ml, and T2 D poorly controlled by medical treatment. All patients relieved a follow-up 3 years after surgery. Results Both groups had similar baseline anthropometric and biochemical measurement. At the three-year follow-up, 22 patients(78.6%) in VSG group and 23 patients(85.2%) in RYGB group achieved complete remission of diabetes mellitus with Hb A1c<6.0%(P=0.525) and without taking diabetic medications and insulin after surgery. Change in Hb A1 c, FBG and C peptide were compared in the two groups. The RYGB group had significantly greater weight loss than the VSG group [percentage of total weight loss. Serum lipids in each group were also greatly improved]. Conclusion In this three-year retrospective analysis, VSG had similar positive effects on diabetes and dyslipidemia compared to RYGB in Chinese T2 DM patients with BMI of 28-35kg/m2. Longer term follow-ups and larger sample studies are needed to confirm these outcomes. Follow up study will investigate the mechanism of the VSG for the T2 D.Part Two Impacts of sleeve gastrectomy on rat intestinal glucose metabolism and gut hormones profilesBackground VSG has proven to be effective for T2 D as RYGB. However, the underlying mechanism is still unclear. RYGB changes the anatomy of the gastric intestinal tract bypassing the proximal intestine, resulting in a decrease of glucose absorption and changes of gut hormones. VSG on the other hand does not change the intestinal anatomy, but is unclear whether is also changes the intestinal glucose metabolism and gut hormone profiles. Objective To investigate the impact of sleeve gastrectomy on rat intestinal glucose metabolism and gut hormones profile. Methods The SD rats were divided into VSG group and control group. 29 days after the primary surgery, the rats were cathetered in the jugular and portal vein and duodenum. Glucose was infused through duodenum catheter and glucose level of the portal and jugular veins were recorded at 0’, 10’, 30’ and 60’. Porttal-systemic glucose gradient and its AUC were calculated. Blood samples were collected and centrifuged. The supernatant was used to examine ghrelin, GIP, GLP-1, glucagon and insulin hormone levels. Results(1) VSG group lost weigh quickly in the first week post operation, and regained afterward. In 4 weeks after operation, the weight in VSG group was still less than control group. 15 days after operation, food intake of VSG group was less than control group.(2) The portal and systemic glucose levels were similar in two groups at 0’ and 60 minutes after duodenum glucose infusion. At 10’ time point, portal-systemic glucose gradient was higher in VSG group versus control group. After that, the glucose gradient was comparable in two groups. AUC of two groups was similar.(3) The portal and systemic ghrelin levels were lower in VSG group than control group at fasting and after duodenum glucose infusion. The portal and systemic GIP levels were higher in VSG group than control group after duodenum glucose infusion, and the fasting levels were similar. The portal GLP-1 levels were higher in VSG group than control group, but the fasting and systemic level was comparable. There were no significant differences with glucagon and insulin levels in the two groups. Conclusion VSG doesn’t change the intestine glucose metabolism in SD rats. VSG significantly deceased ghrelin hormone and increased GIP and GLP-1 hormones secretion.Part Three Impacts of Sleeve gastrectomy on rat intestinal morphology and GLP-1 secretion cellsBackground It has shown that RYGB causes intestine to undergo hypertrophy due to indisgested food entering intestine sooner and changes in gut hormone profile. Sleeve gastrectomy can also entering the intestine sooner, but it is not clear whether VSG has impacts on the intestinal morphology and GLP-1 secretion cells. Objective To investigate the impacts of VSG on rat intestinal morphology and GLP-1 secretion cells, and compare the intestinal differences between VSG and RYGB groups. Methods Intestine segments from Trietz ligament to ileocecal valve were collected for VSG, RYGB and control. Intestine samples were weighed and fixed with Paraformaldehyde and OCT, followed by 5μm section on glass slides. Samples were processed with Haematoxylin and Eosin staining and Immunohistochemical approaches. Intestinal morphology was analyed by optical microscopy. GLP-1 cells were counted with confocal laser microscopy. Results(1) Intestine sample weight was higher for RYGB group than VSG and control group. There was no significant differences between VSG and control group..(2) 45 rats were completed the intestinal morphological study with optical microscopy(15 in each group). There was no significant differences(P=0.028) with depth of crypt, length of villus and thickness of muscle layer in three groups of BP limb. Of Roux limb, the depth of crypt, length of villus and thickness of muscle layer were higher in RYGB group than the other two groups, and the VSG group was similar with control group of intestinal morphology. Of the common limb, the depth of crypt and thickness of muscle layer were higher in RYGB group, and VSG group was similar with control group. There were no significant differences with length of villus in three groups in common limb. Of terminal ileum segment, thickness of muscle layer was higher in RYGB group than control group, and there were no significant differences with depth of crypt and the length of villus in three groups and thickness of muscle layer in VSG and control group.(3) 34 rats were completed immunohistochemical study. Of the VSG and control group, the GLP-1 cells in TI limb were more than the other three segments, GLP-1 cells in BP limb were the least, and GLP-1 cells in Roux limb were comparable with common limb. In the RYGB group, GLP-1 cells in BP limb were the least, the GLP-1 cells in Roux limb were more than BP limb and less than common limb and TI limb, and common limb was similar with TI limb. Between the three groups, GLP-1 cells in BP limb, Roux limb and TI limb were similar, GLP-1 cells in common limb in RYGB group were more than the other two groups, and VSG group GLP-1 cells in common limb was similar with control limb. Conclusion RYGB can induce morphological hypertrophy in Roux and common limbs, and GLP-1 cell to proliferate. VSG has no impact on the intestinal morphology and does not include and GLP-1 cell proliferation.