PMID- 29502278
OWN - NLM
STAT- MEDLINE
DCOM- 20190923
LR  - 20221207
IS  - 1708-0428 (Electronic)
IS  - 0960-8923 (Linking)
VI  - 28
IP  - 8
DP  - 2018 Aug
TI  - The Effects of Laparoscopic Sleeve Gastrectomy with Duodenojejunal Bypass on 
      Japanese Patients with BMI < 35 kg/m(2) on Type 2 Diabetes Mellitus and the 
      Prediction of Successful Glycemic Control.
PG  - 2429-2438
LID - 10.1007/s11695-018-3179-y [doi]
AB  - BACKGROUND: Laparoscopic sleeve gastrectomy with duodenojejunal bypass (LSG-DJB) 
      is a combination of sleeve gastrectomy and proximal intestinal bypass through 
      duodenal exclusion. This technique has shown excellent weight loss and 
      anti-diabetic effects in severely obese patients. In this retrospective study, we 
      examined the clinical effects of LSG-DJB on mildly obese patients (body mass 
      index (BMI) < 35 kg/m(2)) with type 2 diabetes mellitus (T2DM) and analyzed 
      factors contributing to the successful postoperative glycemic control. METHODS: 
      Seventy-two consecutive Japanese patients with T2DM with a BMI of < 35 kg/m(2) 
      who underwent LSG-DJB in a single institution from September 2007 to March 2015 
      were included for the study. Weight loss, safety, and the impact on T2DM and 
      metabolic syndrome were examined at 1 year after surgery when weight loss reaches 
      an expected plateau. In addition, pre- and postoperative factors between those 
      who achieved diabetes remission (remitters) and non-remitters were compared. 
      RESULTS: The follow-up rate at 1 year after surgery was 93%. The mean percent 
      total weight loss (%TWL) was 31.6 +/- 8.8%, and the mean glycosylated hemoglobin 
      (HbA1c) dropped from 8.9 +/- 1.5 to 6.4 +/- 1.0%. There were four early- and seven 
      late-severe complications (grade III-A or more based on the Clavien-Dindo 
      classification), which account for the 1-year morbidity rate of 15%. There was no 
      mortality. The complete (HbA1c of < 6% without diabetes medication) and partial 
      (HbA1c of < 6.5% without diabetes medication) remission of T2DM was achieved in 
      31 and 49% of the patients, respectively. Positive impacts were also observed on 
      hypertension and dyslipidemia. Consequently, the ratio of those who achieved the 
      composite endpoint (HbA1c of < 7%, low-density lipoprotein cholesterol 
      < 100 mg/dL, systolic blood pressure < 130 mmHg) significantly increased from 4.2 
      to 22% (p = 0.003). Duration of T2DM and preoperative use of anti-hypertensive 
      drugs were independent predictors of diabetes remission. Patients with a higher 
      ABCD score were also at a higher rate of success in T2DM remission. CONCLUSIONS: 
      LSG-DJB for T2DM patients with a BMI of < 35 kg/m(2) is a feasible and effective 
      surgical method in achieving moderate weight loss and excellent improvement of 
      glycemic control, metabolic syndrome, and cardiovascular risk although the T2DM 
      remission rate was lower compared with severely obese individuals. Proper patient 
      selection for candidates of the procedure is imperative to effectively predict 
      poor responders.
FAU - Seki, Yosuke
AU  - Seki Y
AUID- ORCID: 0000-0002-3474-5671
AD  - Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, 
      Chiyoda-ku, Tokyo, 102-0084, Japan. yosuke_seki@hotmail.com.
FAU - Kasama, Kazunori
AU  - Kasama K
AD  - Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, 
      Chiyoda-ku, Tokyo, 102-0084, Japan.
FAU - Yasuda, Kazuki
AU  - Yasuda K
AD  - Department of Metabolic Disorder, Diabetes Research Center, Research Institute, 
      National Center for Global Health and Medicine, Tokyo, Japan.
FAU - Yokoyama, Renzo
AU  - Yokoyama R
AD  - Center for Clinical Research, Okinawa Prefectural Chubu Hospital, Okinawa, Japan.
FAU - Porciuncula, Jose Paolo
AU  - Porciuncula JP
AD  - Weight Management and Bariatric-Metabolic Surgery Center, St. Luke's Medical 
      Center, Quezon City, Philippines.
FAU - Kurokawa, Yoshimochi
AU  - Kurokawa Y
AD  - Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, 
      Chiyoda-ku, Tokyo, 102-0084, Japan.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Obes Surg
JT  - Obesity surgery
JID - 9106714
RN  - 0 (Blood Glucose)
RN  - 0 (Glycated Hemoglobin A)
SB  - IM
CIN - Obes Surg. 2018 Aug;28(8):2528-2529. PMID: 29675636
MH  - Adult
MH  - *Blood Glucose/metabolism
MH  - Body Mass Index
MH  - *Diabetes Mellitus, Type 2/surgery
MH  - Duodenum/surgery
MH  - Female
MH  - Gastrectomy/methods
MH  - Glycated Hemoglobin/metabolism
MH  - Humans
MH  - Japan
MH  - Jejunoileal Bypass
MH  - Laparoscopy/methods
MH  - Male
MH  - Middle Aged
MH  - Obesity/surgery
MH  - *Obesity, Morbid/surgery
MH  - Patient Selection
MH  - Postoperative Period
MH  - Retrospective Studies
MH  - Treatment Outcome
MH  - Weight Loss/physiology
OTO - NOTNLM
OT  - Class I obesity
OT  - Diabetes
OT  - Japanese
OT  - LSG-DJB
OT  - Metabolic surgery
EDAT- 2018/03/05 06:00
MHDA- 2019/09/24 06:00
CRDT- 2018/03/05 06:00
PHST- 2018/03/05 06:00 [pubmed]
PHST- 2019/09/24 06:00 [medline]
PHST- 2018/03/05 06:00 [entrez]
AID - 10.1007/s11695-018-3179-y [pii]
AID - 10.1007/s11695-018-3179-y [doi]
PST - ppublish
SO  - Obes Surg. 2018 Aug;28(8):2429-2438. doi: 10.1007/s11695-018-3179-y.