The Effect of Gastric Bypass with a Distal Gastric Pouch on Glucose Tolerance and Diabetes Remission in Type 2 Diabetes Sprague-Dawley Rat Model.

BACKGROUND

Gastric bypass with a proximal gastric pouch (Roux-en-Y gastric bypass) induces early diabetes remission. The effect of gastric bypass with a distal gastric pouch remains unknown.

OBJECTIVE

To observe the effect on glucose tolerance and diabetes remission of gastric bypass with a distal gastric pouch.

METHOD

A type 2 diabetes (T2D) model was created in 44 Sprague-Dawley (SD) rats that randomly underwent Roux-en-Y gastric bypass (RYGB, n = 8); gastric bypass with duodenal-jejunal transit (GB-DJT, n = 8); distal-pouch gastric bypass with duodenal-jejunal transit (DPGB-DJT, n = 8); distal-pouch gastric bypass with duodenal-jejunal bypass (DPGB-DJB, n = 8); sham (n = 6); and Roux-en-Y gastric bypass with esophageal re-anastomosis (RYGB-Er, n = 6) surgery. In the DPGB-DJT and the DPGB-DJB groups, the gastric pouch was created in the distal stomach. In the RYGB and the GB-DJT groups, the gastric pouch was created in the proximal stomach. An oral glucose tolerance test (OGTT), insulin tolerance test (ITT) and mixed-meal tolerance test (MMTT) conducted preoperatively were repeated postoperatively.

RESULTS

GLP-1 AUC recorded preoperatively was significantly increased 8 weeks postoperatively in the RYGB, GB-DJT, and DPGB-DJB groups. Increased GLP-1 AUC in the DPGB-DJT did not reach statistical significance. Improved glucose tolerance in the RYGB and GB-DJT groups was significantly higher than DPGB-DJT group. DPGB-DJB did not improve glucose tolerance significantly. Gastrin level was increased significantly in the DPGB-DJT and DPGB-DJB groups.

CONCLUSION

In gastric bypass, creating the gastric pouch in the distal region of the stomach significantly impairs the glucose tolerance and diabetes remission in spite of the increased GLP-1 and insulin responses in T2D SD rat model, suggesting that bypassing the distal stomach may be the key mediator of early diabetes remission after RYGB.