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Differential Effects of Laparoscopic Sleeve Gastrectomy and Laparoscopic Gastric Bypass on Appetite, Circulating Acyl-ghrelin, Peptide YY3-36 and Active GLP-1 Levels in Non-diabetic Humans |
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| Authors: | Ahmed Yousseif Julian Emmanuel Efthimia Karra Queensta Millet Mohamed Elkalaawy Andrew D. Jenkinson Majid Hashemi Marco Adamo Nicholas Finer Alberic G. Fiennes Dominic J. Withers Rachel L. Batterham |
| Affiliation: | 1. Centre for Obesity Research Department of Medicine, University College London, Rayne Institute, 5, University Street, WC1E 6JJ, London, UK 2. Centre for Weight Loss, Metabolic and Endocrine Surgery, University College London Hospitals, 250 Euston Road, NW1 2BU, London, UK 3. Clinical and Experimental Surgery Department, Medical Research Institute, University of Alexandria, Hadara, Alexandria, Egypt 4. Surrey Weight Loss Centre, St Anthony’s Hospital North, Cheam, SM3 9DW, UK 5. Metabolic Signalling Group, Medical Research Council Clinical Sciences Centre, Imperial College, W12 0NN, London, UK 6. Biomedical Research Centre, National Institute of Health Research University College London Hospitals, W1T 7DN, London, UK |
| Abstract: | Laparoscopic Roux-en-Y gastric bypass (LRYGBP) reduces appetite and induces significant and sustainable weight loss. Circulating gut hormones changes engendered by LRYGBP are implicated in mediating these beneficial effects. Laparoscopic sleeve gastrectomy (LSG) is advocated as an alternative to LRYGBP, with comparable short-term weight loss and metabolic outcomes. LRYGBP and LSG are anatomically distinct procedures causing differential entero-endocrine cell nutrient exposure and thus potentially different gut hormone changes. Studies reporting the comparative effects of LRYGBP and LSG on appetite and circulating gut hormones are controversial, with no data to date on the effects of LSG on circulating peptide YY3-36 (PYY3-36) levels, the specific PYY anorectic isoform. In this study, we prospectively investigated appetite and gut hormone changes in response to LRYGBP and LSG in adiposity-matched non-diabetic patients. Anthropometric indices, leptin, fasted and nutrient-stimulated acyl-ghrelin, active glucagon-like peptide-1 (GLP-1), PYY3-36 levels and appetite were determined pre-operatively and at 6 and 12 weeks post-operatively in obese, non-diabetic females, with ten undergoing LRYGBP and eight adiposity-matched females undergoing LSG. LRYGBP and LSG comparably reduced adiposity. LSG decreased fasting and post-prandial plasma acyl-ghrelin compared to pre-surgery and to LRYGBP. Nutrient-stimulated PYY3-36 and active GLP-1 concentrations increased post-operatively in both groups. However, LRYGBP induced greater, more sustained PYY3-36 and active GLP-1 increments compared to LSG. LRYGBP suppressed fasting hunger compared to LSG. A similar increase in post-prandial fullness was observed post-surgery following both procedures. LRYGBP and LSG produced comparable enhanced satiety and weight loss. However, LSG and LRYGBP differentially altered gut hormone profiles. |
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