Can Chinese T2D Patients With BMI 20-32.5 kg/m 2 Benefit From Loop Duodenojejunal Bypass With Sleeve Gastrectomy?

Surg Obes Relat Dis. 2019 Sep;15(9):1513-1519. doi: 10.1016/j.soard.2019.03.027. Epub 2019 Mar 26.


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.

Keywords: Complications; Loop duodenojejunal bypass with sleeve gastrectomy; Low BMI; Predictor; Remission; Type 2 diabetes.