Response to glucose tolerance testing and solid high carbohydrate challenge: comparison between Roux-en-Y gastric bypass, vertical sleeve gastrectomy, and duodenal switch

Abstract

Compared to gastric bypass, DS results in greater weight loss and improves insulin sensitivity and glucose homeostasis without causing a hyperinsulinemic response. Because the response to challenge after VSG is intermediary, pyloric preservation alone cannot account for this difference.

Hypoglycemia in everyday life after gastric bypass and duodenal switch

“…However, in line with the altered glucose absorption routes postsurgery, it has been noted that the peak levels of glucose and insulin during meal tests are lower in DS patients (21), and they are also lower in DS patients as compared to post-GBP or post-sleeve gastrectomy surgery patients (22). Furthermore, patients who have undergone biliopancreatic diversion, a procedure performed in DS, exhibit insulin supersensitivity (23).…”

The rationale for a duodenal switch as the primary surgical treatment of advanced type 2 diabetes mellitus and metabolic disease

“…In contrast, the DS results in euglycemia without hyperinsulinemia [30]. For this to occur, the effect has to be peripheral and involve reduced insulin resistance at the cellular level, especially in muscle or liver.…”

“…The effect on DS seems to be away from the pancreas. During our comparative study [30], when challenged with glucose, DS patients did not have a hyper-insulinemic response.…”

“…Very little time is spent euglycemic. In comparison, the majority of time spent after VSG is spent in a normal range [30].…”

Relationship between gastric pouch and weight loss after laparoscopic sleeve gastrectomy

“…Now it is considered a full primary bariatric procedure, safe and effective even as conversion procedure after failure or complications of other bariatric operations [8,9]. Several different mechanisms have been postulated to lead to weight loss after LSG, such as the reduced expansibility and capacity of the sleeved stomach [10], the higher pressure induced by solid food intake [11], improved mitochondrial respiration [12] and insulin sensitivity [13,14], and lower plasma levels of ghrelin [15], mainly produced in the fundic region by specialized gastric cells [16,17]. In common clinical practice, the radiological followup was usually indicated only for patients with symptoms or unsatisfactory weight loss curve, but the correlation between gastric fundus at follow-up upper gastrointestinal series (UGS) and weight loss remains unclear [18].…”