The Effect of Antrum Size on Weight Loss, Glucagon-Like Peptide-1 (GLP-1) Levels, and Glycemic Control Following Laparoscopic Sleeve Gastrectomy in Adolescents with Obesity and Type 2 Diabetes

• Published in: Obesity surgery 2021-10, Vol.31 (10), p.4376-4385
• Main Authors: Shehata, Mohamed A., Elhaddad, Ahmed, El-Attar, Ashraf A., Shehata, Sherif M.
• Format: Article
• Language: English
• Subjects: Diabetes; Gastrointestinal surgery; Medicine; Medicine & Public Health; Original Contributions; Peptides; Surgery; Teenagers; Weight control
• ISSN: 0960-8923; 1708-0428
• DOI: 10.1007/s11695-021-05590-9

Purpose The aim of this study was to compare the effect of antral resection versus antral preservation sleeve gastrectomy on the post-operative GLP-1, glycemic control, and weight loss in adolescents suffering from severe obesity and type 2 diabetes (T2D). Materials and methods This study included 36 adolescents. Patients were randomly divided into 2 groups: group (A) and group (B) . Each group included 18 patients who underwent LSG, starting transection at 2 cm or 5 cm from the pyloric ring in group (A) and group (B) , respectively. They were followed up at 1, 3, 6, 12, and 24 months post-operatively. The outcomes were the post-operative GLP-1 response, glycemic control, weight loss, and safety. Results The improvements in the body mass index and the percentage of excess weight loss (%EWL) were statistically significant within each group. The mean GLP-1 levels showed significant increase at the 1, 3, and 6 months but not in the 12 and 24 months in all the studied samples within each group. The mean HbA1c levels and post-prandial serum C-peptide significantly improved within each group (P < 0.05). No statistical differences in the weight loss, %EWL, GLP-1, HbA1c, C-peptide changes, and complication rates were observed between both groups. Diabetic remission was significantly higher (88.9%) in group (A) . Conclusions LSG resulted in generalized significant GLP-1 initial response that decreased over time. The reduced antrum size did not influence the GLP-1 response, glycemic control, or insulin resistance, but resulted in significantly better T2D remission. Since the study examines a small number of patients, further studies are needed. Trial Registration ClinicalTrials.gov Identifier: NCT04388059 Graphical Abstract