Biliopancreatic Diversion Preserving the Stomach and Pylorus in the Treatment of Hypercholesterolemia and Diabetes Type II: Results in the First 10 cases

Noya, Giuseppe; Cossu, Maria Laura; Coppola, M. Nicholas; Tonolo, Giancarlo; Angius, M. F.; Fais, E.; Ruggiu, Matteo

doi:10.1381/096089298765555088

Cited by 45 publications

(24 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Studies in rodents have shown that DJB improves diabetes both in obese (Zucker fa/fa rats) (19) and lean (GK rats) (6) type 2 diabetic animals, consistent with several clinical observations of diabetes remission when RYGB or BPD are performed in moderately obese (11,12) or even lean patients (13). On the other hand, other parameters may better define both the risk from diabetes and the diabetes-related outcomes of surgery.…”

Section: Is Type 2 Diabetes An Operable Intestinal Disease?supporting

confidence: 82%

“…In spite of the fact that the operation did not cause significant changes in BMI and body weight, these patients had normal plasma glucose and A1C levels. Remission of diabetes in nonmorbidly obese patients has also been reported after RYGB and BPD (11)(12)(13). Earlier reports also documented diabetes improvement and/or remission after gastrectomy and partial gastric resections (14), which, like DJB and RYGB, are characterized by a variable degree of bypass of the proximal small bowel.…”

Section: Figure 2-enhancing Delivery Of Nutrients To the Hindgut Withmentioning

confidence: 85%

See 1 more Smart Citation

Is Type 2 Diabetes an Operable Intestinal Disease?

2008

View full text Add to dashboard Cite

Type 2 diabetes, which accounts for 90 -95% of all cases of diabetes, is a growing epidemic that places a severe burden on health care systems, especially in developing countries. Because of both the scale of the problem and the current epidemic growth of diabetes, it is a priority to find new approaches to better understand and treat this disease. Gastrointestinal surgery may provide new opportunities in the fight against diabetes. Conventional gastrointestinal operations for morbid obesity have been shown to dramatically improve type 2 diabetes, resulting in normal blood glucose and glycosylated hemoglobin levels, with discontinuation of all diabetes-related medications. Return to euglycemia and normal insulin levels are observed within days after surgery, suggesting that weight loss alone cannot entirely explain why surgery improves diabetes. Recent experimental studies point toward the rearrangement of gastrointestinal anatomy as a primary mediator of the surgical control of diabetes, suggesting a role of the small bowel in the pathophysiology of the disease. This article presents available evidence in support of the hypothesis that type 2 diabetes may be an operable disease characterized by a component of intestinal dysfunction.

show abstract

Section: Is Type 2 Diabetes An Operable Intestinal Disease?supporting

confidence: 82%

Section: Figure 2-enhancing Delivery Of Nutrients To the Hindgut Withmentioning

confidence: 85%

Is Type 2 Diabetes an Operable Intestinal Disease?

2008

View full text Add to dashboard Cite

show abstract

“…Conventional weight-loss diets and drug therapy are usually ineffective for severe obesity and bariatric surgery has been proposed as an alternative therapy. Among the different bariatric surgical techniques, biliopancreatic diversion, with or without stomach preservation, is characterized by lipid maladsorption with a significant reduction of circulating lipids as we have previously observed [9]. A low plasma level of LDL cholesterol does not always mean a favorable lipidic pattern depending also on the level of plasma HDL cholesterol and LDL size.…”

Section: Introductionmentioning

confidence: 93%

Plasma Lipids and Lipoprotein Changes after Biliopancreatic Diversion for Morbid Obesity

Brizzi

Angius²,

Carboni³

et al. 2003

Dig Surg

View full text Add to dashboard Cite

Background: The reduction in plasma cholesterol with increase in large and lower dense LDL (pattern A) obtained by statins is usually associated with a prompt reduction in cardiovascular risk, but after bariatric surgery for morbid obesity a delay of some years is observed. No data regarding LDL pattern are available in obese subjects after biliopancreatic surgery. Objective: To evaluate the modifications in LDL composition and LDL density after biliopancreatic surgery. Subjects: 29 patients (17 type 2 diabetics (type 2) and 12 non-diabetics (ND)) with BMI <35, who failed previous attempts to decrease weight by diet, were studied before and 6 months after biliopancreatic diversion for morbid obesity. Measurements: In all subjects, besides fasting circulating lipids, glucose and insulin, LDL and VLDL composition were determined and LDL density was evaluated as well. Results: After surgery we observed a significant reduction of all circulating lipids, including apolipoprotein (Apo) B. The decrease was more marked for total cholesterol (–41%) than for triglycerides (–28%), without a significant difference between type 2 and ND. After surgery, LDL presented a marked decrease in the percentage of cholesterol (from 36 to 32%) with a marked increase in the percentage of triglycerides (from 13 to 18%), without appreciable modification of ApoB. After surgery, 1 patient changed from pattern B to A, while 2 patients previously pattern A became pattern B. Also a decrease in HDL and ApoAI was evident in all the subjects with an increase in the VLDL-1. Conclusions: Our data indicate that after biliopancreatic diversion, the plasma lipid profile improves along with improvement of plasma glucose and insulin sensitivity, but the LDLs become richer in triglycerides. It is possible that the greater atherogenicity of these LDLs is compensated by an improvement in the general metabolic condition.

show abstract

“…Cet effet s'explique non seulement par la malabsorption des aliments ingérés, mais également par les modifications hormonales induites par le court-circuit digestif [21]. Quelques publications ont rapporté des résultats positifs également chez des patients DT2 avec un IMC < 35 kg/m² [22][23][24] (tableau I). Néanmoins, compte tenu des carences nutritionnelles que cette technique est susceptible de provoquer, la dérivation bilio-pancréatique ne paraît pas repré-senter la technique chirurgicale de premier choix chez le patient DT2 avec un IMC < 35 kg/m².…”

Section: Dérivation Bilio-pancréatiqueunclassified

De la chirurgie bariatrique à la chirurgie métabolique : vers un nouveau paradigme dans le traitement du diabète de type 2

Scheen

Flines

Roover

et al. 2011

Médecine des Maladies Métaboliques

View full text Add to dashboard Cite

De la chirurgie bariatrique à la chirurgie métabolique : vers un nouveau paradigme dans le traitement du diabète de type 2 From bariatric surgery to metabolic surgery: Towards a new paradigm for the management of type 2 diabetes RésuméLa chirurgie bariatrique induit de nombreuses modifications hormonales qui contribuent à réduire la sensation de faim et à améliorer l'homéostasie glycémique chez le patient diabétique de type 2. La meilleure connaissance de ces mécanismes physiopathologiques, particulièrement bien étudiés en ce qui concerne la dérivation gastrique avec anse de Roux en Y, a conduit à une certaine innovation dans les techniques chirurgicales proposées et à envisager d'utiliser celles-ci chez des patients diabétiques de type 2 sans obésité sévère (indice de masse corporelle < 35 kg/m², voire < 30 kg/m²). Ainsi, on pourrait évoluer d'une chirurgie bariatrique classique vers une chirurgie dite métabolique et s'orienter vers un nouveau paradigme dans le traitement du diabète de type 2. Cette approche innovante, prometteuse mais encore insuffisamment validée, mérite d'être mieux évaluée, dans une approche multidisciplinaire impliquant une collaboration étroite entre chirurgiens digestifs, gastro-entérologues et endocrino-diabétologues. Mots-clés :Chirurgie bariatrique -chirurgie métabolique -dérivation gastro-intestinale -diabète de type 2 -hormones digestives -obésité. Summary Bariatric surgery induces numerous hormonal changes that could contribute to reduce hunger sensation and improve glucose homeostasis in patients with

show abstract

Biliopancreatic Diversion Preserving the Stomach and Pylorus in the Treatment of Hypercholesterolemia and Diabetes Type II: Results in the First 10 cases

Abstract: Our experience with the procedure found that this new method seems to be as effective in controlling lipidic metabolism and diabetes II as the original version of BPD. As expected, weight loss is only moderate, so that the modified BPD is not suitable for very obese patients.

Cited by 45 publications

References 7 publications

Is Type 2 Diabetes an Operable Intestinal Disease?

Is Type 2 Diabetes an Operable Intestinal Disease?

Plasma Lipids and Lipoprotein Changes after Biliopancreatic Diversion for Morbid Obesity

De la chirurgie bariatrique à la chirurgie métabolique : vers un nouveau paradigme dans le traitement du diabète de type 2

Contact Info

Product

Resources

About