Enteroendocrine Physiological Changes in Superobese Patients Submitted to Two Different Bariatric Procedures, Determine Whether BPD With DS or SADI-S as Primary or Revisional Surgery is Superior Than the Other as First Choice for the Superobese, Determine Whether or Not Revision Surgery is as Effective as Primary Surgery and Understand the Physiological Mechanisms Inherent in These Putative Differences
Conditions
Keywords
Bariatric Surgery, Superobesity, Revisional Bariatric Surgery, Single anastomosis duodeno-ileal bypass, Biliopancreatic diversion with duodenal switch
Brief summary
This study aims to understand the enteroendocrine physiological changes in superobese patients submitted to two different bariatric procedures (biliopancreatic diversion with duodenal switch versus single anastomosis duodeno-ileal bypass), when perfomed as primary or revisional surgeries (after a sleeve gastrectomy). The main purpose is to establish the metabolic changes obtained with the sleeve gastrectomy and how the revisional procedure maximizes those changes. Additionally, the study will determine whether BPD with DS or SADI-S is superior than the other as first choice for the superobese. The study will monitor the enteroendocrine function before and after the ingestion of a mixed meal, in pre-operatory and post-surgery timepoints, comparing both primary and revisional surgeries.
Detailed description
Abstract Obesity is a chronic disease whose global incidence keeps rising as the twenty first century goes on. Nowadays, the surgical approach constitutes the best treatment option for these patients, making the sleeve gastrectomy and the gastric bypass the more frequently performed bariatric surgeries. However, the superobese patients (IMC≥ 50kg/m2) present variable weight loss resistance to the previous techniques, showing better results when submitted to disabsorptive procedures, namely the biliopancreatic diversion with duodenal switch, and the more recently created single anastomosis duodeno-ileal bypass. Each constitutes a revisional surgery option after a primary sleeve gastrectomy, reducing surgical and anesthesia risks. This has brought to light that some superobese patients do not need the revisional procedure as they achieve the weight loss target solely by the vertical gastrectomy. Supported on the investigators' previous work and extensive experience performing both techniques, they now aim to understand the enteroendocrine physiological changes which each procedure accomplishes and compare them in terms of therapeutic efficacy among the superobese. The utmost goals will be to unravel the advantages of BPD-DS and SADI-S as primary or revisional surgeries, the differences between patients that respond well to sleeve gastrectomy alone and those who do not, and, finally, providing further insights on which procedure should be favoured over the other based on the patient characteristics. Study Overview: Participants in this study will have been submitted to either BPD-DS or SADI-S, as a primary or as a revisional surgery. * Participants visits will be scheduled before surgery and after surgery at 3, 6 , 12 and 24 months for those who receive BPD-DS or SADI-S as a primary procedure. * Those who are firstly submitted to the sleeve gastrectomy, visits will be scheduled before surgery and after surgery at 3 , 6 and 12 months. The revisional surgery will take place 1 year after the sleeve, with visits scheduled before surgery and after surgery at 3, 6 and 12 months. In all these visits, detailed participants assessment will include vitals, anthropometric and biochemical evaluation, and the performance of a MMTT with plasma sampling for hormonal profiles. Intraoperative sampling of visceral and subcutaneous adipose tissue will take place during BPD-DS or SADI-S as a primary procedure and during the sleeve gastrectomy and repeated 1 year after the revisional surgery, either BPD-DS or SADI-S, is performed. Participant Enrolment: Participants will be selected from the cohort of patients referred for multidisciplinary evaluation by the clinical team for surgical treatment of obesity of the Centro Hospitalar Entre Douro e Vouga (CHEDV). Participants found to be suitable according to the entry criteria and who have accepted to participate will be enrolled in the study and assigned to one of the four study groups according to participants clinical features.
Interventions
PROCEDURESingle anastomosis duodeno-ileal bypass
Sleeve gastrectomy followed by division of the duodenum bypassing the jejunum with end-to-side duodeno-ileal diversion
Sleeve gastrectomy, followed by division of the duodenum bypassing the jejunum with end-to-side duedeno-ileal diversion and Roux-en-y entero-enteric anastomosis, leaving 100 cm common channel.
PROCEDURESADI-S as a revisional procedure
In patients previously submitted to sleeve gastrectomy a single anastomosis duodeno-ileal bypass will be performed as 2nd time surgery
PROCEDUREBPD-DS as a revisional procedure
In patients previously submitted to sleeve gastrectomy a biliopancreatic diversion with duodenal switch will be performed as 2nd time surgery
Sponsors
Instituto de Ciências Biomédicas Abel Salazar
The Novo Nordisk Foundation Center for Basic Metabolic Research
Hospital de Sao Sebastiao
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
Bariatric surgery candidates * BMI between 45 and 55 kg/m2 * Aged between 18 and 65 years at surgery
Exclusion criteria
* Previous abdominal surgery * Diabetic patients (Hb A1c \> 5,7%) prior to the bariatric procedure * Treatment with antidiabetic drugs, except for purposes other than diabetes treatment, prior to the bariatric procedure
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in GIP dynamic profile | From enrolment to 12 months post-intervention in 4 visits: preoperative, 3, 6 and 12 months post-surgery | Glucose-dependent insulinotropic polypeptide (GIP) will be measured in pmol/L. This parameter will be assessed at each study timepoint |
| Change in body mass index | From enrolment to 12 months post-intervention in 4 visits: preoperative, 3, 6 and 12 months post-surgery | Body mass index (BMI) combines height (in meters) and weight (in kilograms) and is calculated as weight over (height)\^2. Therefore, it will be reported in kg/m\^2. This parameter will be determined at each study timepoint (pre-operatory, 3, 6 and 12 months post-surgery) at presential visits to the clinic. |
| Change in glycated haemoglobin | From enrolment to 12 months post-intervention in 4 visits: preoperative, 3, 6 and 12 months | Glycated haemoglobin (HbA1c) will be measured in percentage (%). This parameter will be assessed at each study timepoint (pre-operatory, 3, 6 and 12 months post- surgery) through routine complete biochemical evaluation. |
| Change in glucose dynamic profile | From enrolment to 12 months post-intervention in 4 visits: preoperative, 3, 6 and 12 months | Glucose will be measured in mmol/L. This parameter will be assessed at each study timepoint (pre-operatory, 3, 6 and 12 months post-surgery) under fasting conditions and during a mixed-meal tolerance teste (MMTT) with blood collection at eight timed intervals (-10, 0, 15, 30, 45, 60, 90 and 120 minutes). |
| Change in insulin dynamic profile | From enrolment to 12 months post-intervention in 4 visits: preoperative, 3, 6 and 12 months post-surgery | Insulin will be measured in mIU/L. This parameter will be assessed at each study timepoint (pre-operatory, 3, 6 and 12 months post-surgery) under fasting conditions and during a mixed-meal tolerance teste (MMTT) with blood collection at eight timed intervals (-10, 0, 15, 30, 45, 60, 90 and 120 minutes). |
| Change in glucagon dynamic profile | From enrolment to 12 months post-intervention in 4 visits: preoperative, 3, 6 and 12 months post-surgery | Glucagon will be measured in pmol/L. This parameter will be assessed at each study timepoint (pre-operatory, 3, 6 and 12 months post-surgery) under fasting conditions and during a mixed-meal tolerance teste (MMTT) with blood collection at eight timed intervals (-10, 0, 15, 30, 45, 60, 90 and 120 minutes). |
| Change in GLP-1 dynamic profile | From enrolment to 12 months post-intervention in 4 visits: preoperative, 3, 6 and 12 months post-surgery | Glucagon-like peptide-1 (GLP-1) will be measured in pmol/L. This parameter will be assessed at each study timepoint (pre-operatory, 3, 6 and 12 months post-surgery) under fasting conditions and during a mixed-meal tolerance teste (MMTT) with blood collection at eight timed intervals (-10, 0, 15, 30, 45, 60, 90 and 120 minutes). |
Secondary
| Measure | Time frame |
|---|---|
| Hypertension remission rates | From enrolment to 12 months post-intervention in 4 visits: preoperative, 3, 6 and 12 months post-surgery |
| Dyslipidemia remission rates | From enrolment to 12 months post-intervention in 4 visits: preoperative, 3, 6 and 12 months post-surgery |
| Sleep Apnea remission rates | From enrolment to 12 months post-intervention in 4 visits: preoperative, 3, 6 and 12 months post-surgery |
| Metabolic syndrome remission rates | From enrolment to 12 months post-intervention in 4 visits: preoperative, 3, 6 and 12 months post-surgery |
Other
| Measure | Time frame |
|---|---|
| Surgical morbidity | From surgery date to 3 months post-surgery |
| Surgical mortality | From surgery date to 3 months post-surgery |
| Late morbidity | From 3 months until 4 years post-surgery |
Countries
Portugal
Contacts
Primary ContactMarta Guimarães, PhD
Backup ContactAna Marta Pereira, MD
Outcome results
None listed