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  • Title: Can Chinese T2D patients with BMI 20-32.5 kg/m2 benefit from loop duodenojejunal bypass with sleeve gastrectomy?
    Author: Lin S, Yang N, Guan W, Liang H.
    Journal: Surg Obes Relat Dis; 2019 Sep; 15(9):1513-1519. PubMed ID: 31548005.
    Abstract:
    BACKGROUND: Loop duodenojejunal bypass with sleeve gastrectomy (LDJB-SG) is a simplified biliopancreatic diversion with duodenal switch. OBJECTIVES: This study investigated the therapeutic outcomes of LDJB-SG and predictors of type 2 diabetes (T2D) remission in Chinese patients with a body mass index (BMI) of 20 to 32.5 kg/m2. SETTING: A university hospital. METHODS: This retrospective study included 28 T2D patients with a BMI of 20 to 32.5 kg/m2 who underwent LDJB-SG. T2DM remission, weight loss, postoperative nutrition status, and complications at 1- and 3-year follow-up were assessed. Remission of T2DM was defined as a fasting blood glucose <7 mmol/L and HbA1C <6.5% for 1 year without pharmacological intervention. RESULTS: At 1-year follow-up after LDJB-SG, the T2D remission rate was 75% (21/28), and the mean total weight loss was 23.6%. The 3-year T2D remission rate and percent of total weight loss were 68.4% (13/19) and 20.3%, respectively. Univariate and multivariate analysis indicated that duration of T2D was the only risk factor associated with T2D remission (P < .05). LDJB-SG improved the metabolic syndrome by increasing the high-density lipoprotein cholesterol level (P = .0157), decreasing waist circumference (P < .0001), and decreasing triglycerides (P = .0053). Postoperative complications of LDJB-SG included malodorous flatus (64.3%), accidental diarrhea induced by greasy food (57.1%), de novo gastroesophageal reflux disease (28.6%), anemia (25%), fatigue (21.4%), underweight (17.9%), intolerance to cooked rice (10.7%), constipation (7.1%), and steatorrhea (3.6%). CONCLUSION: LDJB-SG resulted in acceptable T2D remission and metabolic improvement at 1- and 3-year follow-up in Chinese T2D patients with a BMI of 20 to 32.5 kg/m2. T2D duration may serve as the predictor of T2D remission. LDJB-SG should be performed with caution because of the high incidence of postoperative complications.
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