Differential GIP/GLP-1 intestinal cell distribution in diabetics’ yields distinctive rearrangements depending on Roux-en-Y biliopancreatic limb length

2018 ◽  
Vol 119 (9) ◽  
pp. 7506-7514 ◽  
Author(s):  
António M. Palha ◽  
Sofia S. Pereira ◽  
Madalena M. Costa ◽  
Tiago Morais ◽  
André F. Maia ◽  
...  
Keyword(s):  
Limb Length ◽  
Intestinal Cell ◽  
Cell Distribution ◽  
Biliopancreatic Limb ◽  
Biliopancreatic Limb Length

scholarly journals Customization of biliopancreatic limb length to modulate and sustain antidiabetic effect of gastric bypass surgery

2018 ◽  
Vol 314 (2) ◽  
pp. G287-G299 ◽  
Author(s):  
A. Pal ◽  
D. B. Rhoads ◽  
A. Tavakkoli
Keyword(s):  
Gastric Bypass ◽  
Weight Regain ◽  
Glucose Utilization ◽  
Hormone Secretion ◽  
Limb Length ◽  
Roux Limb ◽  
Dose Response Relationship ◽  
Biliopancreatic Limb ◽  
Relationship Of ◽  
Biliopancreatic Limb Length

Although Roux-en-Y Gastric Bypass (RYGB) remains the most effective treatment for obesity and type 2 diabetes (T2D), many patients fail to achieve remission, or relapse. Increasing intestinal limb lengths of RYGB may improve outcomes, but the mechanistic basis for this remains unclear. We hypothesize biliopancreatic (BP) limb length modulates the antidiabetic effect of RYGB. Rats underwent RYGB with a 20-cm (RYGB-20cm) or 40-cm (RYGB-40cm) BP limb and were compared with control animals. After 2 and 4 wk, portal and systemic blood was sampled during intestinal glucose infusion. Portosystemic gradient was used to calculate intestinal glucose utilization (Gutil), absorption (Gabsorp), and hormone secretion. Intestinal morphology and gene expression were assessed. At 2 wk, Gabsorp progressively decreased with increasing BP limb length; this pattern persisted at 4 wk. Gutil increased ≈70% in both RYGB-20cm and -40cm groups at 2 wk. At 4 wk, Gutil progressively increased with limb length. Furthermore, Roux limb weight, and expression of hexokinase and preproglucagon, exhibited a similar progressive increase. At 4 wk, glucagon-like peptide-1 and -2 levels were higher after RYGB-40cm, with associated increased secretion. We conclude that BP limb length modulates multiple antidiabetic mechanisms, analogous to the dose-response relationship of a drug. Early postoperatively, a longer BP limb reduces Gabsorp. Later, Gutil, Roux limb hypertrophy, hormone secretion, and hormone levels are increased with longer BP limb. Sustained high incretin levels may prevent weight regain and T2D relapse. These data provide the basis for customizing BP limb length according to patient characteristics and desired metabolic effect. NEW & NOTEWORTHY Biliopancreatic limb length in gastric bypass modulates multiple antidiabetic mechanisms, analogous to the dose-response relationship of a drug. With a longer biliopancreatic limb, Roux limb hypertrophy, increased glucose utilization, reduced glucose absorption, and sustained high incretin levels may prevent weight regain and diabetes relapse.

scholarly journals Should Roux-en-Y gastric bypass biliopancreatic limb length be tailored to achieve improved diabetes outcomes?

Medicine ◽  
2017 ◽  
Vol 96 (48) ◽  
pp. e8859 ◽  
Author(s):  
Mário Nora ◽  
Tiago Morais ◽  
Rui Almeida ◽  
Marta Guimarães ◽  
Mariana P. Monteiro
Keyword(s):  
Gastric Bypass ◽  
Limb Length ◽  
Diabetes Outcomes ◽  
Biliopancreatic Limb ◽  
Biliopancreatic Limb Length

scholarly journals The role of alimentary and biliopancreatic limb length in outcomes of Roux-en-Y gastric bypass

2020 ◽  
Vol 15 (2) ◽  
pp. 290-297
Author(s):  
Sattar Darabi ◽  
Abdoreza Pazouki ◽  
Fatemeh Hosseini-Baharanchi ◽  
Ali Kabir ◽  
Mohammad Kermansaravi
Keyword(s):  
Gastric Bypass ◽  
Limb Length ◽  
Biliopancreatic Limb ◽  
Biliopancreatic Limb Length

Biliopancreatic Limb Length in One Anastomosis Gastric Bypass: Which Is the Best?

2020 ◽  
Vol 30 (10) ◽  
pp. 3685-3694 ◽  
Author(s):  
Francesco Pizza ◽  
Francesco Saverio Lucido ◽  
Dario D’Antonio ◽  
Salvatore Tolone ◽  
Claudio Gambardella ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Limb Length ◽  
One Anastomosis Gastric Bypass ◽  
Biliopancreatic Limb ◽  
Biliopancreatic Limb Length

Revisional Surgery for Insufficient Loss or Regain of Weight After Roux-en-Y Gastric Bypass: Biliopancreatic Limb Length Matters

2019 ◽  
Vol 30 (3) ◽  
pp. 804-811 ◽  
Author(s):  
Marko Kraljević ◽  
Thomas Köstler ◽  
Julian Süsstrunk ◽  
Ioannis I. Lazaridis ◽  
Amy Taheri ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Revisional Surgery ◽  
Limb Length ◽  
Regain Of Weight ◽  
Biliopancreatic Limb ◽  
Biliopancreatic Limb Length

MGB-OAGB: Effect of Biliopancreatic Limb Length on Nutritional Deficiency, Weight Loss, and Comorbidity Resolution

2018 ◽  
Vol 28 (11) ◽  
pp. 3439-3445 ◽  
Author(s):  
Anmol Ahuja ◽  
Om Tantia ◽  
Ghanshyam Goyal ◽  
Tamonas Chaudhuri ◽  
Shashi Khanna ◽  
...  
Keyword(s):  
Weight Loss ◽  
Nutritional Deficiency ◽  
Limb Length ◽  
Biliopancreatic Limb ◽  
Biliopancreatic Limb Length ◽  
Comorbidity Resolution

The importance of the biliopancreatic limb length in gastric bypass: A systematic review

2019 ◽  
Vol 15 (1) ◽  
pp. 43-49 ◽  
Author(s):  
Luis F. Zorrilla-Nunez ◽  
Anthony Campbell ◽  
Giulio Giambartolomei ◽  
Emanuele Lo Menzo ◽  
Samuel Szomstein ◽  
...  
Keyword(s):  
Systematic Review ◽  
Gastric Bypass ◽  
Limb Length ◽  
Biliopancreatic Limb ◽  
Biliopancreatic Limb Length
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