The Duodenal–Jejunal Bypass Liner for the Treatment of Type 2 Diabetes Mellitus and/or Obesity: a Systematic Review

This systematic literature review applies the GRADE approach to evaluate the efficacy and safety of the duodenal–jejunal bypass liner (DJBL) for the treatment of (a) patients with obesity?≥?grade II (with comorbidities) and (b) patients with type 2 diabetes mellitus?+?obesity?≥?grade I. We included ten studies with a total of 342 patients that primarily investigated a prototype of the DJBL. In high-grade obese patients, short-term excess weight loss was observed. For the remaining patient-relevant endpoints and patient populations, evidence was either not available or ambiguous. Complications (mostly minor) occurred in 64–100 % of DJBL patients compared to 0–27 % in the control groups. Gastrointestinal bleeding was observed in 4 % of patients. We do not yet recommend the device for routine use.     

Preserve Common Limb in Duodenal–Jejunal Bypass Surgery Benefits Rats with Type 2-Like Diabetes

Background

In order to understand the underlying mechanisms by which weight loss surgeries improve metabolic profiles in type 2 diabetes mellitus (T2DM) patients and to evaluate the relevance of the length of the common limb in modulating various aspects of metabolism, we performed regular duodenal–jejunal bypass (DJB) and long-limb DJB (LL-DJB) surgeries in Goto-Kakizaki (GK) rats and compared their effects on glycemic control.

Methods

Male GK rats at 12 weeks of age were used for this study. Body weight, food intake, fasting glucose, glucagon-like peptide-1 (GLP-1) level, glucose tolerance, insulin sensitivity, cholesterol and triglycerides levels, and fecal energy content were monitored for 26 weeks after the two types of surgeries.

Results

We performed systematic analyses on GK rats after DJB or long-limb surgeries. Both procedures prevented body weight gain, reduced blood glucose and lipid levels, increased GLP-1 levels, and led to better insulin sensitivity. In general, LL-DJB displayed better effects than DJB, except that both surgeries caused similar increase in GLP-1 levels.

Conclusions

Both DJB and LL-DJB surgeries triggered beneficial effects in GK rats. LL-DJB showed better outcomes than DJB, which may be due to reduced food intake and higher fecal energy content. This indicates that the length of the common limb could influence metabolic profiles of surgery recipients.     

Greater Curvature Plication with Duodenal–Jejunal Bypass: a Novel Metabolic Surgery for Type 2 Diabetes Mellitus

Objective

The study investigated the use of great curvature plication with duodenal–jejunal bypass (GCP-DJB) in a type 2 diabetic with obesity rat model.

Methods

Twenty-two Sprague-Dawley rats were given a high fat and sugar diet with subsequent intraperitoneal injection of a small dosage of streptozotocin (30 mg/kg) and randomly assigned to either GCP-DJB (n?=?12) or Sham surgery (n?=?10). Body weight, peripheral blood glucose, and fasting serum insulin were assayed, and insulin resistance index (IRI) was calculated, before and at 1, 2, 4, and 8 weeks after surgery.

Results

No differences were found in the preoperative characteristics of the two groups (P?>?0.05). At week 1, the body weights decreased significantly, but there was no significant difference between the two groups (P?>?0.05).The fasting blood glucose was significantly lower in the GCP-DJB than in the Sham group (P?<?0.05), serum insulin levels were higher (P?<?0.05), and IRI began to decline (P?<?0.05). From 2 to 8 weeks, the body weight of Sham group gradually recovered and continued to rise, while the GCP-DJB group remained at a relatively lower state. Compared to the Sham group, the body weight, fasting blood glucose as well as IRI of GCP-DJB rats had significantly decreased (P?<?0.05). But, the fasting insulin concentrations had significantly increased (P?<?0.05).

Conclusion

This novel GCP-DJB procedure established a stable animal model for the study of metabolic surgery to treat type 2 diabetes mellitus (T2DM).

     

Type 2 Diabetes Control in a Nonobese Rat Model Using Sleeve Gastrectomy with Duodenal–Jejunal Bypass (SGDJB)

Background

As a new bariatric procedure, sleeve gastrectomy with duodenal?Cjejunal bypass (SGDJB) needs further assessment. We compared the diabetic control between SGDJB and sleeve gastrectomy (SG) in Goto?CKakizaki (GK) rats, a nonobese rat model of type 2 diabetes. Our aim is firstly to develop a nonobese diabetic rat model for SGDJB and secondly to investigate the feasibility and safety of SGDJB to induce diabetes remission.

Methods

Fifty 11-week-old male GK rats were divided into five groups: sham-operated SG (SOSG), sham-operated SGDJB (SOSGDJB), control, SG, and SGDJB. Rats were observed for 16?weeks after surgery. The body weight, food intake, glycemic control outcomes, ghrelin, peptide YY (PYY), insulin, glucagon-like peptide 1 (GLP-1), and glucose-dependent insulinotropic peptide were measured.

Results

The operated groups showed lower food intake since 4?weeks postoperation and significant weight loss since 6?weeks postoperation. SGDJB and SG surgeries induced a decreased fasting ghrelin level and increased levels of glucose-stimulated insulin, GLP-1, and PYY secretion at 2 and 16?weeks postoperation. Compared with the SG group, the SGDJB group showed higher glucose-stimulated GLP-1 levels. Both SGDJB and SG groups exhibited significant improvement in oral glucose tolerance and insulin tolerance compared with sham-operated and control groups, but there was no difference between the operated groups.

Conclusions

This nonobese diabetic rat model may be valuable in studying the effect of SGDJB on diabetic control. SGDJB shows similar improvement of glucose metabolism with SG. Our findings do not provide evidence for the foregut-mediated amelioration in glucose homeostasis.     

Early Changes in Incretin Secretion After Laparoscopic Duodenal–Jejunal Bypass Surgery in Type 2 Diabetic Patients

Background  

A stomach-preserving duodenal–jejunal bypass (DJB) has been used for the treatment of type 2 diabetes mellitus (DM) since Rubino et al. first reported a prospective trial. However, there has been no report on changes in incretin secretion after DJB. We aimed to investigate whether DJB changes incretin secretion in nonmorbidly obese type 2 diabetic patients.     

Duodenal–Jejunal Bypass Improves Glucose Metabolism and Adipokine Expression Independently of Weight Loss in a Diabetic Rat Model

Background

There is accumulating evidence that adipokines lead to a proinflammatory state, which plays crucial roles in insulin resistance and development of type 2 diabetes mellitus (T2DM). Previous studies demonstrated that weight loss after bariatric surgery is accompanied by a suppression of the proinflammatory state. However, the effect of bariatric surgery on adipokine expression beyond weight loss is still elusive. The aim of this study was to investigate the effect of duodenal–jejunal bypass (DJB) on glucose homeostasis and adipokine expression independently of weight loss.

Methods

A T2DM rat model was developed by a high-fat diet and low dose of streptozotocin. Twenty-one diabetic rats and 10 age-matched SD rats were randomly assigned to the DJB group, sham-DJB (S-DJB) group, and control group. For 12 weeks after surgery, their body weight, food intake, glucose homeostasis, lipid parameters, serum adipokine levels, and adipokine gene expression in the mesocolon adipose tissue were measured.

Results

Compared to the S-DJB group, DJB induced significant and sustained glycemic control with improved insulin sensitivity and glucose tolerance independently of weight loss. DJB improved the lipid metabolism by decreasing fasting free fatty acids and triglycerides. Serum leptin and IL-6 significantly decreased 12 weeks after DJB, whereas adiponectin increased and TNF-α remained unchanged. The mRNA expression levels of leptin, TNF-α, and IL-6 decreased, whereas adiponectin increased in the mesocolon adipose tissue.

Conclusion

DJB reduced the proinflammatory adipokines and increased the anti-inflammatory adipokines independently of weight loss, which may contribute to the improvement of insulin sensitivity.     

The Effect of Duodenal–Jejunal Bypass on Glucose-Dependent Insulinotropic Polypeptide Secretion in Wistar Rats

Background  

Enteroendocrine K cells secrete the incretin hormone glucose-dependent insulinotropic peptide (GIP) and are predominately located in the duodenum. GIP levels should decrease after gastric bypass due to duodenal exclusion; however, studies have found conflicting data regarding the changes in GIP secretion after gastric bypass and duodenal–jejunal bypass (DJB).     

Laparoscopic Single-Anastomosis Duodenal–Jejunal Bypass with Sleeve Gastrectomy (SADJB-SG): Short-term Result and Comparison with Gastric Bypass

Laparoscopic duodeno–jejunal bypass with sleeve gastrectomy (DJB-SG) has been introduced as a novel metabolic surgery from Asia recently. It provides benefits of avoiding the risk of remnant gastric cancer, minimization of malnutrition from duodenal switch. Here, we introduce the technique of single-loop anastomosis duodeno–jejunal bypass with sleeve gastrectomy (SADJB-SG) and compare with other gastric bypass surgeries. Fifty morbid obese patients underwent our novel procedure, laparoscopic SADJB-S from 2011 to 2013. Operative complication, weight loss, and diabetes remission were followed. All procedures were completed laparoscopically. The mean operative time was 181.7?±?38.4 min, and the mean hospital stay was 3.8 days. Three minor early complications (6 %) were encountered but no major complication was noted. There was no significant difference in perioperative parameters between the SADJB-SG and gastric bypass except a longer operation time. The mean BMI decreased from 38.4 to 25.4 at 1 year after surgery with a mean weight loss of 32.7 % which is higher than gastric bypass. Laparoscopic SADJB-SG appears to be an ideal metabolic/bariatric surgery, whereas the efficacy is non-inferior to gastric bypass.     

Duodenal–Jejunal Bypass Surgery Enhances Glucose Tolerance and Beta-Cell Function in Western Diet Obese Rats

Background  

The aim of this study was to investigate the effect of the duodenal–jejunal bypass (DJB) on glucose homeostasis and islet insulin secretion in Western diet (WD) obese rats.     

Why Does the Gastric Bypass Control Type 2 Diabetes Mellitus?

The remarkable control of diabetes by the gastric bypass remains to be explained. Although it may be totally due to the weight loss induced by the operation, it is likely that the detour of the hormonally active foregut plays a role as well. This keynote address explores the pathophysiology of non-insulin-dependent diabetes mellitus and reviews the data which support the thesis that the gastric antrum, duodenum, and proximal jejunum modulate glucose metabolism and insulin action.     

Duodenal–Jejunal Bypass Improves Glucose Homeostasis in Association with Decreased Proinflammatory Response and Activation of JNK in the Liver and Adipose Tissue in a T2DM Rat Model

Background

There is accumulating evidence that obesity leads to a proinflammatory state, which plays crucial roles in insulin resistance and development of type 2 diabetes mellitus (T2DM). Previous studies demonstrated that weight loss after bariatric surgery was accompanied by a suppression of the proinflammatory state. However, the effect of bariatric surgery on the proinflammatory state and associated signaling beyond weight loss is still elusive. The objective of this study was to investigate the effect of duodenal–jejunal bypass (DJB) on glucose homeostasis, the proinflammatory state and the involving signaling independently of weight loss.

Methods

A high-fat diet and low-dose streptozotocin administration were used to induce T2DM in male Sprague–Dawley rats. The diabetic rats underwent DJB or sham surgery. The blood glucose, glucose tolerance and insulin resistance were determined to evaluate the glucose homeostasis. Serum insulin, GLP-1 and hsCRP were detected by ELISA. The gene expression of TNF-α, IL-6, IL-1β and MCP-1 in liver and fat was determined by quantitative real-time RT-PCR. The JNK activity and serine phosphorylation of IRS-1 in liver and adipose tissue were determined by Western blotting.

Results

Compared to the S-DJB group, DJB induced significant and sustained glycemic control with improved insulin sensitivity and glucose tolerance independently of weight loss. DJB improved the proinflammatory state indicated by decreased circulating hsCRP and proinflammatory gene expression in the liver and adipose tissue. The JNK activity and serine phosphorylation of IRS-1 in liver and adipose tissue were significantly reduced after DJB.

Conclusions

DJB achieved a rapid and sustainable glycemic control independently of weight loss. The data indicated that the improved proinflammatory state and decreased JNK activity after DJB may contribute to the improved glucose homeostasis.     

Laparoscopic Duodenal–Jejunal Exclusion in the Treatment of Type 2 Diabetes Mellitus in Patients with BMI < 30 kg/m2 (LBMI)

Background

The association between medical and dietetic–behavioral treatments of type 2 diabetes mellitus (T2DM) has demonstrated to have variable results. The surgical treatment of T2DM is justifiable after the observation of a successful glycemic control in patients submitted to Roux-en-Y gastric bypass and biliopancreatic diversion. Experiments have shown an important role of the proximal intestine in glycemia decrease and diabetes control.

Methods

Twenty diabetic patients underwent laparoscopic duodenal–jejunal exclusion. The variables studied were body mass index (BMI), fasting glycemia, glycosylated hemoglobin (HbA₁c), and C-peptide, in the preoperative period and after 3 and 6 months.

Results

There was a BMI decrease up to the third month and a weight stabilization between the third and sixth months. There was a significant reduction in fasting glycemia (43.8%) and HbA₁c (22.8%) up to the sixth month (p?p?Conclusions Preliminary results have shown an important effect of the laparoscopic duodenal–jejunal exclusion in the treatment of T2DM. Studies with longer follow-up and a larger number of patients are necessary to better define the role of this new and promising procedure.     

The Effect of 6 and 12 months Duodenal-Jejunal Bypass Liner Treatment on Obesity and Type 2 Diabetes: a Crossover Cohort Study

Objective

The aim of this research was to study the duodenal-jejunal bypass liner (DJBL) treatment for obesity and type 2 diabetes mellitus (T2DM) in patients after dietary treatment in a cross-over design.

Background

DJBL treatment has been proven effective for treatment of obesity and T2DM. However, data on safety and efficacy of a 12-month DJBL treatment is limited.

Methods

In 2014, our research group reported on a multicenter randomized clinical trial. Patients were randomized to DJBL or dietary treatment (control group). Twenty-eight patients crossed over after their dietary treatment and received up to 12 months of DJBL treatment. Patient visits were conducted at baseline, during DJBL treatment (1 week, 1–6, 9, 12 months) and 6 months after removal of the liner. Patients underwent a standard physical examination, blood sampling, assessment of adverse events, nutritional and diabetes counseling, and a standardized meal tolerance test.

Results

Of the 28 patients included in this study, 24 patients completed 6 months of treatment. Eighteen patients were extended to 12 months of DJBL treatment; 13 patients completed this treatment period. After 6 months of DJBL treatment, a significant increase in excess weight loss (EWL) and decrease in weight, BMI, HbA1c, fasting glucose, cholesterol, HDL and LDL improved significantly. After 12 months of DJBL treatment, these parameters stabilized.

Conclusions

The DJBL is an effective, minimally invasive treatment option. Even after successful treatment with dietary restrictions, the DJBL is still capable of significantly reducing weight and improving cardiovascular and type 2 diabetes mellitus parameters in obese patients.

     

Metabolic Surgery Comparing Sleeve Gastrectomy with Jejunal Bypass and Roux-en-Y Gastric Bypass in Type 2 Diabetic Patients After 3 Years

Introduction

Sleeve gastrectomy with jejunal bypass (SGJB) and Roux-en-Y gastric bypass (RYGB) has shown good results with respect to type 2 diabetes mellitus (T2D) remission in our institution. In this study, we compared the efficacy and safety of SGJB versus RYGB in terms of T2D remission up to 3 years postoperatively.

Materials and Methods

A retrospective cohort study of two groups of patients with T2D who underwent SGJB or RYGB. All patients were matched by age, presurgical body mass index (BMI), glycated hemoglobin (HbA1c), and diabetes duration. Complete remission was defined as HbA1c of <?6%, fasting plasma glucose (FPG) of <?100 mg/dL, and no antidiabetic drugs.

Results

In total, 57 and 55 patients in the SGJB and RYGB groups, respectively, met the inclusion criteria. The diabetes remission rate was similar between the SGJB and RYGB groups at 1 year postoperatively (69.2 vs. 64.7%) and 3 years postoperatively (56.1 vs. 58.8%). There were no significant differences in HbA1c or FPG at 1 or 3 years between the two groups. Additionally, weight loss and other metabolic parameters were similar between the groups. Clinical chemistry values were similar at 12 months except for hematocrit and calcium, which were significantly lower in the RYGB group. There were no differences in surgical complications.

Conclusions

Both procedures showed similar results in terms of T2D remission and other metabolic markers at 3 years. Hematocrit and calcium were significantly higher in the SGJB than RYGB group. SGJB is as effective and safe as RYGB in obese patients with T2D.

     

Can a Protocol for Glycaemic Control Improve Type 2 Diabetes Outcomes After Gastric Bypass?

Background  

Roux-en-Y gastric bypass surgery (RYGB) is an effective treatment for patients with type 2 diabetes (T2DM). Tight glycaemic control immediately after RYGB for T2DM may improve long-term glycaemic outcomes, but is also associated with a higher risk of hypoglycaemia. We designed a treatment algorithm to achieve optimal glycaemic control in patients with insulin-treated T2DM after RYGB and evaluated its feasibility, safety and efficacy.     

Stimulation of Autophagy Improves Endoplasmic Reticulum Stress–Induced Diabetes

Accumulation of misfolded proinsulin in the β-cell leads to dysfunction induced by endoplasmic reticulum (ER) stress, with diabetes as a consequence. Autophagy helps cellular adaptation to stress via clearance of misfolded proteins and damaged organelles. We studied the effects of proinsulin misfolding on autophagy and the impact of stimulating autophagy on diabetes progression in Akita mice, which carry a mutation in proinsulin, leading to its severe misfolding. Treatment of female diabetic Akita mice with rapamycin improved diabetes, increased pancreatic insulin content, and prevented β-cell apoptosis. In vitro, autophagic flux was increased in Akita β-cells. Treatment with rapamycin further stimulated autophagy, evidenced by increased autophagosome formation and enhancement of autophagosome–lysosome fusion. This was associated with attenuation of cellular stress and apoptosis. The mammalian target of rapamycin (mTOR) kinase inhibitor Torin1 mimicked the rapamycin effects on autophagy and stress, indicating that the beneficial effects of rapamycin are indeed mediated via inhibition of mTOR. Finally, inhibition of autophagy exacerbated stress and abolished the anti-ER stress effects of rapamycin. In conclusion, rapamycin reduces ER stress induced by accumulation of misfolded proinsulin, thereby improving diabetes and preventing β-cell apoptosis. The beneficial effects of rapamycin in this context strictly depend on autophagy; therefore, stimulating autophagy may become a therapeutic approach for diabetes.In eukaryotic cells, secreted proteins undergo cotranslational folding in the endoplasmic reticulum (ER) lumen. The β-cell ER faces a high protein-folding burden due to the high proinsulin biosynthesis rate: proinsulin mRNA may reach 20% of total mRNA (1) and proinsulin production 50% of total protein synthesis in stimulated β-cells (2). Furthermore, correct folding of proinsulin is difficult due to its complex tertiary structure, containing three disulfide bonds that depend on the redox state of the ER, which can be altered by the inflammation and oxidative stress of nutrient overload and obesity (3,4). Indeed, several reports showed that ER stress is linked to β-cell dysfunction in type 2 diabetes (4–7).The causality between proinsulin misfolding and β-cell failure is epitomized in the mutant INS gene–induced diabetes of youth syndrome, in which mutations in proinsulin trigger irreparable misfolding (8,9). As an example, the C(A7)Y proinsulin mutation results in severe congenital diabetes in man and in the Akita mouse. The pathophysiology of β-cell failure in Akita is complex and involves trapping of nonmutant proinsulin in the ER, leading to impaired β-cell function, stress, and apoptosis (10–12). Notably, a subset of Akita β-cells can compensate for proinsulin misfolding, thereby avoiding diabetes (13). Therefore, unraveling the adaptive mechanisms that operate in stressed β-cells may have important implications for diabetes treatment.Accumulation of misfolded proteins in the ER stimulates the unfolded protein response (UPR), an adaptive homeostatic signaling pathway aimed to reduce stress. The UPR increases the expression of ER chaperones and oxireductases, inhibits mRNA translation, and stimulates ER-associated degradation, thus reducing ER protein load and enhancing folding capacity and clearance of misfolded proteins. However, if ER stress is not subdued, its continuous activation results in apoptosis. ER stress induces autophagy to eliminate damaged organelles and protein aggregates, thus improving cell function and survival (14). This comprises the transport of cytosolic portions and entire organelles to lysosomes via double-membrane vesicles called autophagosomes. Lysosomal degradation recycles amino and fatty acids for energy production in starvation, but also serves an important homeostatic function in response to stress in nutrient abundance (15). Transgenic mice with impaired β-cell autophagy exhibited decreased insulin secretion, glucose intolerance, and islet degeneration, indicating that basal autophagy is required for β-cell well being (16,17). The nutrient-sensing kinase mammalian target of rapamycin complex 1 (mTORC1) is an important regulator of autophagy (18–20). Under nutrient availability, mTORC1 phosphorylates Atg13, which prevents binding to Atg1 (ULK1 in mammals) and hence reduced formation of the Atg1–Atg13–Atg17 complex (21). Conversely, mTORC1 inhibition during starvation or by rapamycin administration stimulates initiation of autophagosome budding.In this study, we studied in Akita β-cells the effects of proinsulin misfolding on autophagy and whether stimulating autophagy using mTORC1 inhibitors attenuates stress and prevents diabetes progression in Akita mice in vivo.     

Proximal Duodenal–Ileal End-to-Side Bypass with Sleeve Gastrectomy: Proposed Technique

Proximal duodenal–ileal end-to-side bypass with sleeve gastrectomy is a new bariatric technique based on the biliopancreatic diversion with duodenal switch in which after the sleeve gastrectomy, the duodenum is anastomosed to the ileum in a Billroth-II fashion. A 200-cm common channel-alimentary limb is devised. Anticipating an appropriate weight loss, at least similar to that obtained after gastric bypass, theoretical benefits for operated patients are a shorter operative time, the performance of only one anastomosis, and no mesentery opening. A prospective trial is now being conducted to find out the results of the procedure and to compare them to those obtained with gastric bypass and standard duodenal switch.     

Duodenal–Jejunal Bypass Surgery Up-Regulates the Expression of the Hepatic Insulin Signaling Proteins and the Key Regulatory Enzymes of Intestinal Gluconeogenesis in Diabetic Goto–Kakizaki Rats

Background

Duodenal–jejunal bypass (DJB), which is not routinely applied in metabolic surgery, is an effective surgical procedure in terms of type 2 diabetes mellitus resolution. However, the underlying mechanisms are still undefined. Our aim was to investigate the diabetic improvement by DJB and to explore the changes in hepatic insulin signaling proteins and regulatory enzymes of gluconeogenesis after DJB in a non-obese diabetic rat model.

Methods

Sixteen adult male Goto–Kakizaki rats were randomly divided into DJB and sham-operated groups. The body weight, food intake, hormone levels, and glucose metabolism were measured. The levels of protein expression and phosphorylation of insulin receptor-beta (IR-β) and insulin receptor substrate 2 (IRS-2) were evaluated in the liver. We also detected the expression of key regulatory enzymes of gluconeogenesis [phosphoenoylpyruvate carboxykinase-1 (PCK1), glucose-6-phosphatase-alpha (G6Pase-α)] in small intestine and liver.

Results

DJB induced significant diabetic improvement with higher postprandial glucagons-like peptide 1, peptide YY, and insulin levels, but without weight loss. The DJB group exhibited increased expression and phosphorylation of IR-β and IRS-2 in liver, up-regulated the expression of PCK1 and G6Pase-α in small intestine, and down-regulated the expression of these enzymes in liver.

Conclusions

DJB is effective in up-regulating the expression of the key proteins in the hepatic insulin signaling pathway and the key regulatory enzymes of intestinal gluconeogenesis and down-regulating the expression of the key regulatory enzymes of hepatic gluconeogenesis without weight loss. Our study helps to reveal the potential role of hepatic insulin signaling pathway and intestinal gluconeogenesis in ameliorating insulin resistance after metabolic surgery.     

Sleeve Gastrectomy with Jejunal Bypass for the Treatment of Type 2 Diabetes Mellitus in Patients with Body Mass Index <35?kg/m2. A cohort study

The objective of this study was to evaluate sleeve gastrectomy with jejunal bypass (SGJB) as a surgical treatment for type 2 diabetes mellitus (T2DM) in patients with a body mass index (BMI) <35 kg/m(2). This is a prospective cohort study. Patients with T2DM and BMI <35 kg/m(2) who underwent SGJB between January 2009 and June 2011 at DIPRECA Hospital, in Santiago, and Hospital Base, Osorno, Chile were included. SGJB consists of creating a gastric tube, which preserves the pylorus, and performing a jejunoileal anastomosis 300 cm distal to the angle of Treitz. Excess weight loss (EWL) and complete or partial remission of T2DM were reported. Forty-nine patients met the inclusion criteria. The mean age was 49 years (36-62), and 53 % of patients were female. Mean preoperative BMI was 31.6 kg/m(2) (25-34.9 kg/m(2)). Operation time was 123 ± 14 min, with 94.7 % of operations performed laparoscopically. Mean postoperative hospital stay was 2 days. Mean postoperative follow-up was 12 months. Median EWL at 1, 3, 6, 12, and 18 months postoperatively was 31.9 %, 56.9 %, 76.1 %, 81.5 %, and 76.1 %, respectively. Complete T2DM remission was achieved in 81.6 % of patients (40/49) and partial remission in 18.4 % (9/49). Forty of 41 patients (97.6 %) on oral hypoglycemic agents achieved complete T2DM remission, and 100 % of insulin-dependent patients stopped using insulin but were still being treated for T2DM. One patient experienced postoperative gastrointestinal bleeding. There were no deaths. SGJB is an effective treatment for T2DM in patients with BMI <35 kg/m(2).