Weight loss induced by Roux-en-Y gastric bypass but not laparoscopic adjustable gastric banding increases circulating bile acids. Ghrelin, leptin, and glycemic control after sleeve gastrectomy versus Roux-en-Y gastric bypass-results of a randomized clinical trial. Weight Loss, Appetite Suppression, and Changes in Fasting and Postprandial Ghrelin and Peptide-YY Levels After Roux-en-Y Gastric Bypass and Sleeve Gastrectomy: A Prospective, Double Blind Study A randomized controlled trial of Roux-en-Y gastrojejunostomy vs. gastroduodenostomy with respect to the improvement of type 2 diabetes mellitus after distal gastrectomy in gastric cancer patients Effect of Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy on Glucose and Gut Hormones: a Prospective Randomised Trial Long-Term Results of a Prospective Comparison of Roux-en-Y Gastric Bypass versus a Variant of Biliopancreatic Diversion in a Non-Superobese Population (BMI 35–50 kg/m2) GLP-1 Plays a Limited Role in Improved Glycemia Shortly After Roux-en-Y Gastric Bypass: A Comparison With Intensive Lifestyle Modification The Effect of Laparoscopic Gastric Banding Surgery on Plasma Levels of Appetite-Control, Insulinotropic, and Digestive Hormones Improved acylated ghrelin suppression at 2 years in obese patients with type 2 diabetes: effects of bariatric surgery vs standard medical therapy Progressive rise in gut hormone levels after Roux‐en‐Y gastric bypass suggests gut adaptation and explains altered satiety Laparoscopic Roux-en-Y gastric bypass for the treatment of morbid obesity: experience with 50 patients. Safety and Efficacy of Roux-en-Y Gastric Bypass to Treat Type 2 Diabetes Mellitus in Non-severely Obese Patients A Prospective Comparison of Vertical Banded Gastroplasty and Roux-en-Y Gastric Bypass in a Non-Superobese Population Diet-induced thermogenesis and respiratory quotient after Roux-en-Y gastric bypass surgery: a prospective study. Acute effects of gastric bypass versus gastric restrictive surgery on β-cell function and insulinotropic hormones in severely obese patients with type 2 diabetes Impact of Bariatric Surgery on Ghrelin and Obestatin Levels in Obesity or Type 2 Diabetes Mellitus Rat Model Roux-en-Y gastric bypass vs sleeve gastrectomy for obese patients with type 2 diabetes: a randomised trial
CONTEXT It has been hypothesized that increased plasma bile acids ( BAs ) contribute to metabolic improvements after Roux-en-Y gastric bypass ( RYGB ) surgery by the G protein-coupled receptor TGR5-mediated effects on glucagon-like peptide-1 secretion and thyroid hormones . OBJECTIVE The objective of this study was to evaluate the importance of bariatric surgery-induced alterations in BA physiology on factors that regulate glucose homeostasis ( insulin secretion and sensitivity ) and energy metabolism ( resting energy expenditure and thyroid hormone axis ) . DESIGN , PARTICIPANTS , INTERVENTION , AND MAIN OUTCOME MEASURE : Eighteen extremely obese subjects were studied before and after 20 % weight loss , induced by either laparoscopic adjustable gastric b and ing ( LAGB ) ( n = 10 ) or RYGB surgery ( n = 8) . RESULTS Plasma BAs more than doubled after RYGB [ fasting : 1.08 ( 0.26 - 1.42 ) to 2.28 ( 1.59 - 3.28 ) μmol/L , P = .03 ; postpr and ial : 2.46 ± 1.59 to 6.00 ± 2.75 μmol/L , P = .01 ] but were either lower or did not change after LAGB [ fasting : 1.80 ( 1.49 - 2.19 ) to 0.92 ( 0.73 - 1.15 ) μmol/L , P = .02 ; postpr and ial : 3.71 ± 2.61 to 2.82 ± 1.75 μmol/L , P = .14 ] . Skeletal muscle expression of TGR5 targets , Kir6.2 and cyclooxygenase IV , increased after RYGB but not LAGB . Surgery-induced changes in BAs were associated with increased peak postpr and ial plasma glucagon-like peptide-1 ( r(2 ) = 0.509 , P = .001 ) and decreased serum TSH ( r(2 ) = 0.562 , P < .001 ) but did not correlate with the change in insulin response to a meal ( r(2 ) = 0.013 , P = .658 ) , insulin sensitivity ( assessed as insulin stimulated glucose disposal during a hyperinsulinemic-euglycemic clamp procedure ) ( r(2 ) = 0.001 , P = .995 ) , or resting energy expenditure ( r(2 ) = 0.004 , P = .807 ) . CONCLUSIONS Compared with LAGB , RYGB increases circulating BAs and TGR5 signaling , but this increase in BAs is not a significant predictor of changes in glucose homeostasis or energy metabolism BACKGROUND Sleeve gastrectomy ( SG ) and Roux-en-Y gastric bypass ( RYGB ) cause weight loss and metabolic improvement , but results of published studies are contradictory . OBJECTIVES The aim of this study was to compare the effects of SG and RYGB on ghrelin , leptin , and glucose homeostasis in a r and omized controlled trial . SETTING University hospital , Pol and . METHODS Seventy-two morbidly obese patients were r and omly selected to undergo either SG ( n = 36 ) or RYGB ( n = 36 ) .  Fasting ghrelin , leptin , glucose , insulin , C-peptide , glucagon , glycated hemoglobin , and homeostasis model assessment of insulin resistance were assessed preoperatively and at 1 , 6 , and 12 months postoperatively . No differences were found in anthropometric and biochemical parameters between the study groups at baseline . RESULTS Sixty-nine ( 95.8 % ) patients completed the study .  Percentage of excess weight loss at 12 months was 67.6±19.3 % after SG and 64.2±18.5 % after RYGB ( P>.05 ) . Fasting ghrelin levels decreased 1 month after SG ( from 76.8 pmol/L to 35.3 pmol/L ; P<.05 ) and remained reduced until 12 months ( 41.6 pmol/L ; P<.05 ) but increased 12 months after RYGB from 74.6 pmol/L to 130.2 pmol/L ( P<.05 ) . Leptin , glucose , insulin , and C-peptide concentrations and glycated hemoglobin and homeostasis model assessment of insulin resistance values decreased significantly in both groups during 12 months . CONCLUSIONS RYGB and SG induce comparable weight loss and improvement in metabolism of glucose . Ghrelin levels decrease after SG and increase after RYGB , but this difference does not affect similar outcomes of these procedures during 1-year follow-up . The contribution of ghrelin to weight loss or metabolic benefits after bariatric surgery is not straightforward , but rather influenced by multiple factors Background : Bariatric surgery is currently the most effective treatment in morbidly obese patients , leading to durable weight loss . Objective : In this prospect i ve double blind study , we aim to evaluate and compare the effects of  laparoscopic Roux-en-Y gastric bypass ( LRYGBP ) with laparoscopic sleeve gastrectomy ( LSG )  on body weight , appetite , fasting , and postpr and ial ghrelin and peptide-YY ( PYY ) levels . Methods : After r and omization , 16 patients were assigned to LRYGBP and 16 patients to LSG .  Patients were reevaluated on the 1st , 3rd , 6th , and 12th postoperative month . Blood sample s were collected after an overnight fast and in 6 patients in each group after a st and ard 420 kcal mixed meal . Results : Body weight and body mass index ( BMI ) decreased markedly ( P < 0.0001 ) and comparably after either procedure . Excess weight loss was greater after LSG at 6 months ( 55.5 % ± 7.6 % vs. 50.2 % ± 6.5 % , P = 0.04 ) and 12 months ( 69.7 % ± 14.6 % vs. 60.5 % ± 10.7 % , [ P = 0.05 ] ) . After LRYGBP fasting ghrelin levels did not change significantly compared with baseline ( P = 0.19 ) and did not decrease significantly after the test meal . On the other h and , LSG was followed by a marked reduction in fasting ghrelin levels ( P < 0.0001 ) and a significant suppression after the meal . Fasting PYY levels increased after either surgical procedure ( P ≤ 0.001 ) . Appetite decreased in both groups but to a greater extend after LSG . Conclusion : PYY levels increased similarly after either procedure . The markedly reduced ghrelin levels in addition to increased PYY levels after LSG , are associated with greater appetite suppression and excess weight loss compared with LRYGBP The purpose of this study is to compare the effect of diabetes control induced by Roux-en-Y gastrojejunostomy(RY ) vs Billroth-I reconstruction(BI ) after distal gastrectomy in patients with early gastric cancer(EGC ) and type 2 diabetes(T2DM ) . Forty EGC patients with T2DM , aged 20–80 years , who were expected to undergo curative distal gastrectomy were r and omized 1:1 to RY(n = 20 ) or BI(n = 20 ) . Diabetes medication status , biochemical and hormonal data including blood glucose , HbA1c , insulin , C-peptide , HOMA-IR , ghrelin , leptin , GLP-1 , PYY , and GIP were evaluated for 12 months after surgery . Although pre- and postoperative 12-month fasting and postpr and ial glucose levels did not show a significant difference , HbA1c , C-peptide , and HOMA-IR levels were significantly improved at 12 months after surgery in both BI and RY groups . Sixty percent of RY patients and 20 % of BI patients decreased their medication satisfying FBS<126 mg/dL and HbA1c<6.5 % and 5 % of BI patients stopped their medication satisfying the criteria of FBS<126 mg/dL and HbA1c<6.0 % . The improvement patterns were more sustainable with less fluctuation in RY than in BI . On hormonal analysis , ghrelin and leptin levels were decreased and PYY and GIP levels were increased at 12 months after surgery in both groups without significant difference according to the reconstruction type and diabetic improvement status except ghrelin . In gastric cancer surgery , RY reconstruction showed better and more durable diabetes control compared to BI during the first year after surgery . Gastric cancer surgery led to decreased ghrelin and leptin and increased PYY and GIP , which might have a role in improving insulin resistance and glucose homeostasis Background  Laparoscopic Roux-en-Y gastric bypass ( LRYGB )  is the most common bariatric technique . Laparoscopic sleeve gastrectomy ( LSG ) is a restrictive procedure ; the metabolic and endocrine effects of which remain unknown . We compared the effects of both procedures on glucose metabolism and fasting and meal-stimulated gut hormone levels . Methods Seven patients were r and omised to LRYGB and eight to LSG .  All patients were evaluated before and at 3 and 12 months postoperatively . Plasma levels of glucose , insulin , ghrelin , leptin , peptide YY ( PYY ) , GLP-1 and pancreatic polypeptide were measured before and after 10 and 60 min of a st and ard test meal ingestion . Results Age , body mass index and preoperative hormone levels were similar in both groups . A significant reduction of plasma glucose and insulin levels was observed after surgery . Moreover , a normalisation of homeostatic model assessment for insulin resistance value was also seen after both procedures . The fasting and postpr and ial leptin levels were significantly lower in the LRYGB group . LSG was followed by a significant reduction in fasting ghrelin levels . In the LRYGB group , GLP-1 levels increased significantly after the test meal . Conclusions LRYGB and LSG markedly improved glucose homeostasis . Only LSG decreased fasting and postpr and ial ghrelin levels , whereas GLP-1 and PYY levels increased similarly after both procedures Background This study presents late results of a previously published 2-year prospect i ve comparison between Roux-en-Y gastric bypass ( RYGBP ) versus biliopancreatic diversion with Roux-en-Y gastric bypass ( BPD-RYGBP ) in an exclusively non-superobese population . Methods From a cohort of 130 patients with a BMI of 35–50 kg/m2 , 65 were r and omly selected to undergo RYGBP and 65 to BPD-RYGBP .  All underwent follow-up evaluation at 1 , 3 , 6 , and 12 months postoperatively and every year thereafter . Results Follow-up at the eighth year was achieved in 60 % of the BPD-RYGBP and in 58 % of the RYGBP group ( p = 1.00 ) . Mean excess weight loss ( EWL% ) , was significantly higher following BPD-RYGBP ( 76.89 ± 1.53 ) as compared to RYGBP ( 67.17 ± 1.43 ) ( p = 0.0004 ) . The mean success rate ( percentage of patients with EWL% ≥50 % ) was significantly higher after BPD-RYGBP ( 95.85 ± 1.01 ) than RYGBP ( 75.91 ± 3.58 ) ( p = 0.0001 ) . No significant differences were observed for late non-metabolic complications . The incidence of anemia , iron deficiency , B12 deficiency , and low-ferritin levels was relatively high in both groups with not always significant differences . Severe protein malnutrition occurred in four patients ( three BPD-RYGBP and one RYGBP ) ( p = 0.37 ) . In only one BPD-RYGBP patient ( 1.54 % ) was revision surgery to RYGBP necessary , due to recurrent episodes of hypoproteinemia . The remaining patients were treated successfully with total parenteral nutrition and nutritional counseling . Conclusions Late results presented in this paper agree with the previously published 2-year results of the same patient cohort . Although both procedures are safe and effective  , BPD-RYGBP seems to prevail in terms of successful weight loss without a significantly higher incidence of metabolic and non-metabolic complications Rapid glycemic improvements following Roux-en-Y gastric bypass ( RYGB ) are frequently attributed to the enhanced GLP-1 response , but causality remains unclear . To determine the role of GLP-1 in improved glucose tolerance after surgery , we compared glucose and hormonal responses to a liquid meal test in 20 obese participants with type 2 diabetes mellitus who underwent RYGB or nonsurgical intensive lifestyle modification ( ILM ) ( n = 10 per group ) before and after equivalent short-term weight reduction . The GLP-1 receptor antagonist exendin(9–39)-amide ( Ex-9 ) was administered , in r and om order and in double-blinded fashion , with saline during two separate visits after equivalent weight loss . Despite the markedly exaggerated GLP-1 response after RYGB , changes in postpr and ial glucose and insulin responses did not significantly differ between groups , and glucagon secretion was paradoxically augmented after RYGB . Hepatic insulin sensitivity also increased significantly after RYGB . With Ex-9 , glucose tolerance deteriorated similarly from the saline condition in both groups , but postpr and ial insulin release was markedly attenuated after RYGB compared with ILM . GLP-1 exerts important insulinotropic effects after RYGB and ILM , but the enhanced incretin response plays a limited role in improved glycemia shortly after surgery . Instead , enhanced hepatic metabolism , independent of GLP-1 receptor activation , may be more important for early postsurgical glycemic improvements Background We hypothesized that  laparoscopic adjustable gastric b and ing ( LAGB )  reduces weight and modulates ghrelin production , but largely spares gastrointestinal endocrine function . To examine this hypothesis , we determined plasma concentrations of appetite-control , insulinotropic , and digestive hormones in relation to LAGB . Methods Twenty-four patients undergoing LAGB were prospect ively enrolled .  Body mass index ( BMI ) was measured and blood sample s obtained at baseline and 6 and 12 months post-surgery . Plasma concentrations of leptin , acylated and total ghrelin , pancreatic polypeptide ( PP ) , insulin , glucose-dependent insulinotropic peptide ( GIP ) , active glucagon-like peptide-1 ( GLP-1 ) , gastrin , and pepsinogens I and II were measured using enzyme-linked immunoassays . Results Median percent excess weight loss ( % EWL ) over 12 months was 45.7 % with median BMI decreasing from 43.2 at baseline to 33.8 at 12 months post-surgery ( p < 0.001 ) . Median leptin levels decreased from 19.7 ng/ml at baseline to 6.9 ng/ml at 12 months post-surgery ( p < 0.001 ) . In contrast , plasma levels of acylated and total ghrelin , PP , insulin , GIP , GLP-1 , gastrin , and pepsinogen I did not change in relation to surgery ( p > 0.05 ) . Pepsinogen II levels were significantly lower 6 months after LAGB but returned to baseline levels by 12 months . Conclusions LAGB yielded substantial % EWL and a proportional decrease in plasma leptin . Our results support the hypothesis that LAGB works in part by suppressing the rise in ghrelin that normally accompanies weight loss . Unchanged concentrations of insulinotropic and digestive hormones suggest that gastrointestinal endocrine function is largely maintained in the long term Objective : Roux-en-Y gastric bypass ( RYGB ) produces more durable glycemic control than sleeve gastrectomy ( SG ) or intensive medical therapy ( IMT ) . However , the contribution of acylated ghrelin ( AG ) , a gluco-regulatory/appetite hormone , to improve glucose metabolism and body composition in patients with type 2 diabetes ( T2D ) following RYGB is unknown . Design : STAMPEDE ( Surgical Treatment and Medication Potentially Eradicate Diabetes Efficiently ) was a prospect i ve , r and omized controlled trial . Subjects : Fifty-three ( body mass index : 36±3 kg m−2 , age : 49±9 years ) poorly controlled patients with T2D ( HbA1c ( glycated hemoglobin ) : 9.7±2 % ) were r and omized to IMT , IMT+RYGB or IMT+SG and underwent a mixed-meal tolerance test at baseline , 12 , and 24 months for evaluation of AG suppression ( postpr and ial minus fasting ) and beta-cell function ( oral disposition index ; glucose-stimulated insulin secretion × Matsuda index ) . Total/ and roid body fat ( dual-energy X-ray absorptiometry ) was also assessed . Results : RYGB and SG reduced body fat comparably ( 15–23 kg ) at 12 and 24 months , whereas IMT had no effect . Beta-cell function increased 5.8-fold in RYGB and was greater than IMT at 24 months ( P<0.001 ) . However , there was no difference in insulin secretion between SG vs IMT at 24 months ( P=0.32 ) . Fasting AG was reduced fourfold following SG ( P<0.01 ) and did not change with RYGB or IMT at 24 months . AG suppression improved more following RYGB than SG or IMT at 24 months ( P=0.01 vs SG , P=0.07 vs IMT ) . At 24 months , AG suppression was associated with increased postpr and ial glucagon-like peptide-1 ( r=−0.32 , P<0.02 ) and decreased and roid fat ( r=0.38 ; P<0.006 ) . Conclusions : Enhanced AG suppression persists for up to 2 years after RYGB , and this effect is associated with decreased and roid obesity and improved insulin secretion . Together , these findings suggest that AG suppression is partly responsible for the improved glucose control after RYGB surgery Bariatric surgery is the most effective treatment for achieving long‐term weight loss in morbidly obese patients . This study investigated prospect i ve changes in gut hormones and metabolic indices after Roux‐en‐$\font\ss = cmss10 scaled 1000 \hbox{\ss Y}$ gastric bypass ( RYGB ) BACKGROUND Roux-en-Y gastric bypass is currently considered the gold st and ard surgical option for the treatment of morbid obesity .  Open RYGB is associated with a high risk of complications . Laparoscopic RYGB has been shown to reduce perioperative morbidity and improve recovery . OBJECTIVES To review our experience with laparoscopic RYGB during a 19 month period . METHODS The data were collected prospect ively . The study group comprised all patients who underwent laparoscopic RYGB for treatment of morbid obesity as their primary operation between February 2006 and July 2007 . The reported outcome included surgical results , weight loss , and improved status of co-morbidities , with follow-up of up to 19 months . RESULTS The mean age of the 50 patients was 36.7 years . Mean body mass index was 44.7 kg/m2 ( range 35 - 76 kg/m2 ) ; mean duration of surgery was 171 minutes . There was no conversion to open surgery . The mean length of stay was 4 days ( range 2 - 7 days ) . Five patients ( 10 % ) developed a complication , but none of them required early reoperation and there were no deaths . Mean follow-up was 7 months ( range 40 days-19 months ) . The excess body weight loss was 55 % and 61 % at 6 and 12 months respectively . Diabetes resolved completely or significantly improved in all five patients with this condition , as did hypertension in eight patients out of nine . CONCLUSIONS Laparoscopic RYGB is feasible and safe . The results in terms of weight loss and correction of co-morbidities are comparable to other previously published studies . However , only surgeons with experience in advanced laparoscopic as well as bariatric surgery should attempt this procedure The efficacy of Roux-en-Y gastric bypass ( RYGB ) to control  type 2 diabetes mellitus ( T2DM )  has been demonstrated in morbidly obese patients . Surgical procedures primarily focused on T2DM control in patients with body mass index ( BMI ) < 35 kg/m2 have shown to effectively induce remission of T2DM . However , only few reports have evaluated the safety and efficacy of RYGB in this group of patients . The aim of this study is to assess the safety and efficacy of RYGB in TD2 M patients with BMI < 35 kg/m2 . All T2DM patients with BMI < 35 kg/m2 and at least 12 months of follow-up who underwent laparoscopic RYGB were included . Safety of the procedure was evaluated according to mortality , need of reoperation/conversion , and complication rates . Metabolic parameters were evaluated at baseline and 6 , 12 , and 24 months after surgery . Thirty patients were included . Seventeen ( 56.6 % ) were women . Age , BMI , and duration of diabetes were 48 ± 9 years , 33.7 ± 1.2 kg/m2 , 4 ± 2.9 years , respectively . No mortality was observed . No conversion/reoperation was needed . Average length of stay was 3.2 ± 0.9 days . Early and late postoperative complications were observed in five ( 16.6 % ) and five ( 16.6 % ) patients , respectively . Twelve months after surgery , remission was observed in 25 of 30 patients ( 83.3 % ) . After 2 years , remission was achieved in 13 of 20 patients ( 65 % ) , and hemoglobin A1c decreased from 8.1 ± 1.8 % to 5.9 ± 1.1 % and homeostasis model assessment of insulin resistance from 5.7 ± 3.2 to 1.9 ± 0.8 after 12 months . RYGB is a safe and effective procedure to induce T2DM remission in otherwise not eligible patients for bariatric surgery . Evidence from prospect i ve studies is needed to vali date this approach Background : In the non-superobese population , consensus is currently unavailable in bariatric surgery . We report the results of a prospect i ve comparison of vertical b and ed gastroplasty ( VBG ) and Roux-en-Y gastric bypass ( RYGBP ) in a non-superobese population . Methods : From 1994 to 2000 , 179 patients with clinical ly severe obesity underwent various surgical procedures in our department . During this time a prospect i ve study was undertaken in order to compare VBG with RYGBP in morbidly obese patients with a BMI < 50 kg/m2 . Based on specific criteria including eating behavior , 68 patients were selected to undergo RYGBP and 35 VBG . All patients have undergone complete follow-up evaluation at 1 , 3 , 6 , and 12 months postoperatively and every year thereafter . Results : All patients have now completed their 5th postoperative year . Mean follow-up period to date is 96.5±12.2 months for VBG and 67.6±11.3 months for RYGBP . 3 patients ( 8.6 % ) in the VBG group and 9 patients ( 13.2 % ) in the RYGBP group are lost to follow-up . Mean excess weight loss ( EWL ) was always better in the RYGBP group ( P=0.0013 ) . The percentage of failure , defined as EWL < 25 % , was not significantly different between the two procedures . No statistically significant differences were observed between the 2 groups in the total number of non-metabolic complications , and the only statistically significant difference observed in metabolic complications was vitamin B12 deficiency after RYGBP . Frequency of vomiting was significantly less and quality of eating significantly better in RYGBP than in VBG patients . Conclusion : This prospect i ve long-term study , with nearly complete follow-up , suggests that in the non-superobese population , preoperative eating habits may play a role in choosing the most appropriate bariatric operation for each patient . Although RYGBP is associated with better mean weight loss outcomes , the percentage of patients who achieved and maintained ≥50 % EWL after VBG in this pre-selected patient population was not significantly different . Each type of operation has advantages and disadvantages , and , if properly chosen , a purely restrictive procedure can be successful for some patients . Therefore , it can be said that the decision regarding which bariatric procedure to perform in non-superobese patients must be based on in-depth preoperative evaluation as well as the patients ' own preferences and outcome expectations BACKGROUND Studies in humans and other animals have shown that Roux-en-Y gastric bypass ( RYGB ) leads to increased energy expenditure ( EE ) . We analyzed several components of EE , such as the respiratory quotient ( RQ ) , resting metabolic rate ( RMR ) , and diet-induced thermogenesis ( DIT ) among patients before and after RYGB . METHODS In this prospect i ve clinical study , RMR , DIT , and RQ were measured by indirect calorimetry ( IC ) in the same patients before and 12 months after RYGB  ( the preoperative and postoperative time points , respectively ) . Postpr and ial RQ and DIT were measured after patients consumed a st and ard ~270 kcal meal ( 62 % carbohydrates , 12 % proteins , and 26 % lipids ) . RESULTS The population studied consisted of 13 patients ( mean age 40.8 ± 6.7 years , 85 % female).At the postoperative ( postop ) time point , patients showed higher weight-adjusted RMR compared with the preoperative ( preop ) time point ( P<.01 ) . The absolute and weight-adjusted metabolic rates 20 minutes after the meal were increased postoperatively ( P<.0001 ) but not preoperatively ( P = 0.2962 ) ( DIT ) ; this increase in RQ was significantly higher in the postop than in the preop time point . CONCLUSION The observed patients showed increased EE , DIT , and RQ after RYGB surgery . These data may serve as important physiologic factors contributing to the loss and maintenance of weight after RYGB Context : Hyperglycemia resolves quickly after bariatric surgery , but the underlying mechanism and the most effective type of surgery remains unclear . Objective : To examine glucose metabolism and β-cell function in patients with type 2 diabetes mellitus ( T2DM ) after two types of bariatric intervention ; Roux-en-Y gastric bypass ( RYGB ) and gastric restrictive ( GR ) surgery .  Design : Prospect i ve , nonr and omized , repeated- measures , 4-week , longitudinal clinical trial . Patients : In all , 16 T2DM patients ( 9 males and 7 females , 52±14 years , 47±9 kg m−2 , HbA1c 7.2±1.1 % ) undergoing either RYGB ( N=9 ) or GR ( N=7 ) surgery . Outcome measures : Glucose , insulin secretion , insulin sensitivity at baseline , and 1 and 4 weeks post-surgery , using hyperglycemic clamps and C-peptide modeling kinetics ; glucose , insulin secretion and gut-peptide responses to mixed meal tolerance test ( MMTT ) at baseline and 4 weeks post-surgery . Results : At 1 week post-surgery , both groups experienced a similar weight loss and reduction in fasting glucose ( P<0.01 ) . However , insulin sensitivity increased only after RYGB , ( P<0.05 ) . At 4 weeks post-surgery , weight loss remained similar for both groups , but fasting glucose was normalized only after RYGB ( 95±3 mg 100 ml−1 ) . Insulin sensitivity improved after RYGB ( P<0.01 ) and did not change with GR , whereas the disposition index remained unchanged after RYGB and increased 30 % after GR ( P=0.10 ) . The MMTT elicited a robust increase in insulin secretion , glucagon-like peptide-1 ( GLP-1 ) levels and β-cell sensitivity to glucose only after RYGB ( P<0.05 ) . Conclusion : RYGB provides a more rapid improvement in glucose regulation compared with GR . This improvement is accompanied by enhanced insulin sensitivity and β-cell responsiveness to glucose , in part because of an incretin effect We aim ed to evaluate the therapeutic efficacy on weight control by different bariatric surgeries and investigate the ghrelin and obestatin changes after these surgeries in obesity and nonobese type 2 diabetes mellitus ( T2DM ) rats . Obese rats were r and omly assigned to receive sleeve gastrectomy ( SG , n = 8) , minigastric bypass ( MGBP , n = 8) , roux-en-Y gastric bypass ( RYGBP , n = 8) , and sham operation ( SO , n = 4 ) . Another 4 rats served as control . Besides , Goto-Kakisaki ( GK ) rats were also r and omly divided into similar groups except for total gastrectomy ( TG , n = 8) group . The results showed that in obese rats , weigh loss in RYGBP group was similar to that in MGBP group but larger than that in SG group . Ghrelin significantly increased in RYGB group , but obestatin increased in MGBP group . Ghrelin/obestatin ratio significantly decreased in SG group . In GK rats , weight loss was most obvious in TG group . Postoperatively , ghrelin was significantly increased in MGBP and RYGB groups but decreased in TG group . Obestatin also showed an increase in MGBP and RYGB groups . Ghrelin/obestatin in TG group decreased significantly . In conclusion , RYGB and MGBP may be more suitable for obese rats , but TG may be the best strategy for T2DM rats to control weight with different mechanisms Aims /hypothesisBariatric surgery is gaining acceptance as a ‘ metabolic surgical intervention ’ for patients with type 2 diabetes . The optimal form of surgery and the mechanism of action of these procedures are much debated . We compared two bariatric procedures for obese patients with type 2 diabetes and evaluated their effects on HbA1c and glucose tolerance . Methods We performed a parallel un-blinded r and omised trial of Roux-en-Y gastric bypass ( RYGB ) vs sleeve gastrectomy ( SG ) in 41 obese patients with type 2 diabetes , who were bariatric surgery c and i date s attending the obesity clinic .  HbA1c , body composition and glucose tolerance were evaluated at baseline , and at 3 and 12 months . Results Of the 41 patients , 37 completed the follow-up ( 19 RYGB , 18 SG ) . Both groups had similar baseline anthropometric and biochemical measures , and showed comparable weight loss and fat : fat-free mass ratio changes at 12 months . A similar normalisation of HbA1c levels was observed as early as 3 months post-surgery ( 6.37 ± 0.71 % vs 6.23 ± 0.69 % for RYGB vs SG respectively , p < 0.001 in both groups for baseline vs follow-up ) . Conclusions /interpretationIn this study , RYGB did not have a superior effect in comparison to SG with regard to HbA1c levels or weight loss during 12 months of follow-up . Trial registration Clinical Trials.gov NCT00667706 Funding This work was supported by grant no. 3 - 000 - 8480 from the Israel Ministry of Health Chief Scientist , the Stephen Morse Diabetes Research Foundation and by Johnson & Johnson
Meta-regression showed that gastric pouch volume , alimentary limb length and biliopancreatic limb length were not associated with changes in ghrelin levels .
Conclusion Fasting total ghrelin levels decreased in the short term ( ≤ 3 months ) and increased in the long term ( > 3 months ) after RYGB
Background Roux-en-Y gastric bypass ( RYGB ) is considered effective for weight loss and for treatment of many obesity-related metabolic diseases .
Ghrelin is an essential orexigenic peptide that plays an indispensable role in controlling body weight and energy homeostasis of post-operative patients .
This systematic review and meta- analysis aim ed to investigate changes in the level of fasting total ghrelin following RYGB .