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GP and LSG

GP and LSG almost equal effective when treating obesity in rats

Stomach is brought up by grasper in gastric plication
The investigators found that there were no significant differences in weight between the groups two weeks before operation, while both the GP and SG groups showed significant weight loss compared to the control group at two and four weeks post-operation

Gastric plication (GP) and laparoscopic sleeve gastrectomy (LSG) procedures achieved almost equal effectiveness by inducing weight loss, reducing food intake, improving glucose tolerance, regulating metabolic hormones and altering gastrointestinal dynamics in obese diabetic rats, according to a study by researchers from Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, China. The study, ‘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’, was published in SOARD.

The authors note that gastric plication (GP) and sleeve gastrectomy (SG) are two 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.”

Subsequently, they sought to assess 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 in Zucker diabetic fatty rats.

In their study, 30 Zucker diabetic fatty rats were equally and randomly divided into three 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 two, four and six weeks post-operation.

They measured whole-body metabolic parameters including activity, energy expenditure and respiratory exchange rate (RER) using metabolic cages three weeks post-operation. The residual gastric and intestinal propulsive movement were measured at six weeks post-operation after all animals were sacrificed.

Outcomes

The investigators found that there were no significant differences in weight between the groups two weeks before operation, while both the GP and SG groups showed significant weight loss compared to the control group at two and four weeks post-operation. At the sixth week post-operation, the SG group weighed markedly less than the sham group, while there was no significant difference in weight between the GP and sham groups.

They also found that there were no statistically significant differences in food intake between the three groups two weeks before operation. The GP and SG groups had a lower average food intake than the sham group at two and four weeks post-operation. Although by six weeks, the reduced food intake in the GP and SG groups versus sham group was not statistically significant.

With regards to FPG, they also noted no significant differences between the groups before operation, however, the FPG levels of the GP and SG groups decreased vigorously and promptly compared with the sham group at two, four and six weeks post-operation. There was no statistically significant difference in FPG level between the GP and SG groups at any time point.

For IPGTTs, they report that glucose tolerance decreased in the sham group but improved in the GP and SG groups by the second week post-operation. By week six, no significant differences were found between the GP and sham groups. In addition, there were no statistically significant differences in glucose tolerance between the SG and GP groups.

Regarding energy expenditure, they determined that the SG and GP groups had remarkably higher energy expenditures compared with the sham group at night. In the daytime, energy expenditure was also higher in the SG group compared to the sham group, but no significant differences were found between the GP and sham groups. They did not find any obvious differences in RER between the GP, SG, and sham groups at night. However, during the day, RER was lower in the GP and SG groups compared to the sham group.

“Our study provides evidence that rats that underwent SG and GP had a lower daytime activity level, decreased RER, and elevated energy consumption compared to the sham group,” the authors noted. “In addition, the SG and GP groups had decreased ghrelin levels and increased GLP-1 levels versus sham. The GP group also showed enhanced intestinal propulsive movement with less gastric residual, while the SG group exhibited reduced intestinal propulsive movement and higher gastric residual.”

The authors acknowledge that compared with rat models, humans have a completely different response to therapy and different pancreatic beta cell physiology and therefore more clinical studies are needed to identify the total effects of the GP and SG procedures.

“Further investigation into the mechanisms by which these procedures help to control diabetes in obese individuals will help physicians understand how and when bariatric surgery may be an ideal therapeutic option for obese type 2 diabetes patients,” the authors concluded.

To access this paper, please click here

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