Bariatric Times

Sleeve Gastrectomy 2015

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

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A20 Bariatric Times • April 2015 • Supplement A 5 th INTERNATIONAL CONSENSUS SUMMIT FOR SLEEVE GASTRECTOMY O ne of the greatest benefits of bariatric surgery is the remission/resolution in comorbid conditions, such as type 2 diabetes mellitus (T2DM). 1 With more than 25 million Americans suffering from this disease and nearly $120 billion spent annually, the treatment of diabetes is of utmost importance. 2 Bariatric surgery has been shown to be an effective and durable treatment of T2DM in individuals with obesity. 1 Supported by a growing body of evidence in the literature, the American Diabetes Association (ADA) has endorsed bariatric surgery for the treatment of T2DM in patients with body mass indices (BMIs) of 35kg/m 2 or greater. 3 Laparoscopic sleeve gastrectomy (LSG) is gaining ground as a safe procedure among the bariatric procedures currently used for treating T2DM in patients with obesity. The LSG is a left partial gastrectomy of the fundus and body to create a long, tubular gastric conduit constructed along the lesser curve of the stomach. Dr. Michel Gagner (Montreal, QC, Canada) first performed LSG as the restrictive part of biliopancreatic diversion with duodenal switch (BPD-DS) in 1999, and later, in 2003, as the first step of a two- stage laparoscopic Roux-en-Y gastric bypass (RYGB). 4 More recently, LSG has become the most common standalone procedure performed in the United States and Asia. 5 Although SG is generally considered a restrictive procedure, the effect of weight loss and diabetes remission could also be related to elicitation of the "ileal break" mechanism. 6 Two of the well-studied gut-derived peptides are glucagon-like peptide-1 (GLP- 1) and peptide YY (PYY). Both GLP-1 and PYY are secreted from L cells in the distal small bowel in response to nutrient intake. 6 Multiple studies have shown that obese individuals have decreased basal and postprandial PYY levels as well as a decreased postprandial GLP-1 response as compared to lean individuals. 7 Patients after LSG experience a more expedited nutrient transport into the distal ileum, eliciting an augmented postprandial secretion of GLP-1 and PYY. 8 Currently, the metabolic mechanisms of action of LSG are a very active area of research. In the clinical realm, early and mid-term data show that LSG produces satisfactory resolution of obesity-related comorbidities, such as T2DM. 9 A meta-analysis published in 2014, 10 included 32 recent studies with a total of 6,526 patients, has compared the effectiveness of SG and RYGB in ameliorating glucose metabolism in obese patients with T2DM. 10 Compared with LSG, RYGB had significantly better effect in resolving T2DM, hypertension, hypercholesterolemia, gastroesophageal reflux disease (GERD), and arthritis. However, RYGB had higher incidence of complications and reoperation and longer operation time than LSG. • Laparoscopic sleeve gastrectomy (LSG) is gaining ground as a safe procedure among the bariatric procedures currently used for treating T2DM in patients with obesity. • In LSG, the effect of weight loss and diabetes remission could be related to elicitation of the "ileal break" mechanism. • A growing body of research and clinical data suggest that LSG has a substantial effect on T2DM, producing remission or improvement in most cases. KEY POINTS Sleeve Gastrectomy for Type 2 Diabetes Mellitus: Mechanism and Evidence ALFONSO TORQUATI, MD, MScI, FACS A ssociate Professor and Chief, Duke University Medical Center, Durham, North Carolina, United States Bariatric Times. 2015;12(4 Suppl A):A20–A21. DISCLOSURE: Dr. Torquati reports no conflicts of interest relevant to the content of this article. ADDRESS CORRESPONDENCE TO: Dr. Alfonso Torquati, Duke University, 407 Crutchfield Street, Durham, NC 27704; E-mail: alfonso.torquati@duke.edu

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