A rodent model of partial intestinal diversion: a novel metabolic operation

Abstract

Background-Metabolic surgery is safe and the most effective therapy for obesity and its comorbidities. New procedures may allow for better tailoring of metabolic surgery to the individual patient.Objective-To evaluate the impact, comparative effectiveness, and mechanisms of the partial intestinal diversion (PID), vertical sleeve gastrectomy (VSG), and the combination of PID and VSG on body weight and glucose regulation.Setting-University research facility, United States.Methods-Three cohorts of high-fat diet-induced obese male rats were randomized to distal partial intestinal diversion (DPID), proximal partial intestinal diversion (PPID), vertical sleeve gastrectomy (VSG), VSG and DPID (VSG/DPID), or sham operation (Sham). Animals were followed for 11 (cohort 1) or 10 (cohorts 2 and 3) weeks. Outcomes included body weight and composition, food intake, glucose metabolism, lipids, bile acids, and energy balance. Statistical comparisons were performed using Tukey's multiple comparison test applied to ANOVA.Results-DPID and not PPID resulted in significant weight and body fat reductions relative to Sham. Improved glucose tolerance was seen in all surgical groups though this reached statistical significance for only DPID and VSG when compared with Sham. Improvements in baseline glucose and insulin, corresponding insulin resistance, and plasma lipids were noted in DPID compared to Sham. Though the magnitude of weight and body composition changes and metabolic benefit tended to be larger for VSG relative to DPID, it only reached statistical significance for lipids. VSG and VSG/DPID resulted in similar outcomes. Markedly reduced food intake occurred after VSG and more modestly after DPID. Stool caloric content was higher in DPID relative to all groups.Conclusions-DPID is an effective metabolic operation resulting in notable weight and fat loss and metabolic improvement relative to sham-operated rodents. Interestingly, combining VSG with DPID added little additional benefit to the effects of VSG.

The Phantom Satiation Hypothesis of Bariatric Surgery

“…Following the same idea, because the stomach is more richly innervated than lower GI segments, surgical operation of the lower intestines should affect feeding to a lesser extent. For instance, duodenal-jejunal exclusion, a procedure that leaves the stomach intact, is significantly less effective at reducing feeding or body weight in animals and humans ( Geloneze et al, 2009 ; Kindel et al, 2011 ; Alvarez et al, 2020 ). In further support of our model, adding gastric vagotomy to gastrectomy does not produce further weight-loss in laboratory rodents ( Hankir et al, 2016 ; Dezfuli et al, 2018 ).…”

Endoscopic and surgical therapy for obesity

“…Nelze brát za referenční hodnotu, že se provádí pouze na jednom pracovišti v České republice. Zajímavě, podle článku od Alvareze, Sandovala a Seeleyho (2020), je efektivita tohoto zákroku v porovnání se slevovou gastrektomií nízká (50). Proto se tento zákrok již nevyužívá.…”