Comparison of Bariatric Surgery Procedurues and Glucose Tolerance

Dr. Mitchell S. Roslin, MD Lenox Hill Hospital Manhattan Minimally Invasive & Bariatric Surgery 186 E 76th Street, 1st Floor New York, NY 10021.MedicalResearch.com Interview with:

Dr. Mitchell S. Roslin, MD
Lenox Hill Hospital Manhattan Minimally Invasive & Bariatric Surgery
186 E 76th Street, 1st Floor New York, NY 10021.


MedicalResearch.com: What are the main findings of the study?

Dr. Roslin: The cornerstone of medical management for weight loss and to prevent weight gain is to regulate glucose and insulin and prevent wide fluctuation.  Yet, Gastric bypass, widely considered the gold standard operation, accentuates these fluctuations.  The purpose of our study was to compare glucose tolerance of gastric bypass, sleeve gastrectomy and a modified version of duodenal switch that  preserves adequate intestine. We found that all operations improve insulin resistance, but that duodenal switch normalizes the curve, whereas gastric bypass causes wide spikes in insulin and glucose.

MedicalResearch.com: Where any of the findings unexpected?

Dr. Roslin: Our initial hypothesis was that by preserving the pyloric valve that is the exit of the stomach, would regulate glucose tolerance.  That wound up being partially true.  Sleeve gastrectomy, which also preserves the pyloric valve had intermediate results to bypass and switch.  This means that there are other things working that explain the ability for duodenal switch to regulate the glucose tolerance curve.

 MedicalResearch.com: What should patients and clinicians take away from this report?

Dr. Roslin: The take away is that I believe that we will find that a modified or simplified version of the duodenal switch, that preserves adequate bowel length, and avoids issues of short bowel, will become the preferential procedure for bariatric surgery and severe type 2 diabetes.

MedicalResearch.com: What further research would you recommend as a result of your study?

Dr. Roslin: Further study should include randomized trials between bypass and proper calibrated duodenal switch with diabetic and non diabetic patients.

 Citation:

Response to glucose tolerance testing and solid high carbohydrate challenge: Comparison between Roux-en-Y gastric bypass, vertical sleeve gastrectomy, and duodenal switch

Surg Endosc. 2013 Sep 10. [Epub ahead of print]
Roslin MS, Dudiy Y, Brownlee A, Weiskopf J, Shah P.
Lenox Hill Hospital, 100 E 77th Street, New York, NY, 10075, USA, mroslin@nshs.edu.