Comparison of the effect by which gastric plication and sleeve gastrectomy procedures alter metabolic and physical parameters in an obese type 2 diabetes rodent model

Abstract

Background: Gastric plication (GP) and sleeve gastrectomy (SG) are 2 restrictive bariatric surgeries that are associated with weight loss and health improvement in patients with obesity. However, differences in how these procedures exert their effects have not been systematically evaluated and compared between techniques.

Objectives: To investigate the effectiveness of GP and SG surgeries for obese patients with type 2 diabetes based on evaluation of energy metabolism, hormone metabolism, and gastrointestinal dynamics.

Setting: University medical center.

Methods: Zucker diabetic fatty rats (n = 30) were equally and randomly divided into 3 groups: sham, GP, and SG. Weight, food intake, fasting plasma glucose (FPG), and intraperitoneal glucose tolerance test (IPGTT) were measured in vivo before operation and at 2, 4, and 6 weeks postoperation. Whole-body metabolic parameters including activity, energy expenditure, and respiratory exchange rate (RER) were measured using metabolic cages 3 weeks postoperation. Blood samples were taken 2 weeks before operation and at 2, 4, and 6 weeks postoperation for the purpose of measuring the expression of serum ghrelin and glucagon-like peptide (GLP-1) by enzyme-linked immunosorbent assay. The residual gastric and intestinal propulsive movement were measured at 6 weeks postoperation after all animals were sacrificed.

Results: Compared with sham, the GP and SG procedures achieved near equivalent levels of efficacy as far as weight loss, reduced food intake, and decreased FBG and IPGTT in our rodent model. The GP and SG procedures also provided the same effectiveness as far as altering serum ghrelin and GLP-1 hormones. In addition, results showed that the GP and SG procedures can increase metabolic rate by consuming more energy and reducing activity. RERs in GP and SG animals were lower than in sham animals, which indicates that the energy mainly comes from adipose tissue. Moreover, the GP procedure showed lower gastric residual compared to sham, while the SG procedure did not appear to have this affect; the SG procedure resulted in deficiencies in intestinal propulsion function.

Conclusions: The GP and SG procedures have the same effectiveness and can help improve diabetes control by regulating weight, glucose tolerance, and metabolic hormones and augmenting gastrointestinal dynamics. Therefore, these procedures have great potential as therapies for obesity and type 2 diabetes.

Keywords: Energy expenditure; Gastric plication; Sleeve gastrectomy; Type 2 diabetes.