Basic Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2025; 17(2): 98585
Published online Feb 27, 2025. doi: 10.4240/wjgs.v17.i2.98585
Proximal small intestinal bypass outperforms Roux-en-Y and jejunoileal bypass in glucose regulation in streptozotocin induced diabetic rats
Chi-Ying Xu, Cai Tan, Xin Luo, Kun Yang, Ren-Ran Wu, Lei Lin, Guan-Lei Liu, Jin-Yuan Duan
Chi-Ying Xu, Xin Luo, Kun Yang, Ren-Ran Wu, Lei Lin, Guan-Lei Liu, Jin-Yuan Duan, Department of General Surgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang 330000, Jiangxi Province, China
Cai Tan, Department of Women’s Health, Jiangxi Maternal and Child Health Hospital, Nanchang 330000, Jiangxi Province, China
Co-first authors: Chi-Ying Xu and Cai Tan.
Author contributions: Xu CY and Tan C wrote the manuscript, they are co-first authors who have made equally contributions; Xu CY, Tan C, and Duan JY designed the research, analyzed data, and prepared manuscript; Xu CY, Tan C, Luo X, and Yang K performed the research; Yang K, Wu RR, Lin L, Liu GL, and Duan JY helped analyze data and discussed the results; and all authors read and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 82360168 and No. 81960154; Natural Science Foundation of Jiangxi Province, No. 20212BAB206020; and the Foundation of Health Commission of Jiangxi Province, No. SKJP220225830.
Institutional animal care and use committee statement: The study was reviewed and approved by the Animal Ethics Committee of the Second Affiliated Hospital of Nanchang University.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at duanjy2022@outlook.com.
ARRIVE guidelines statement: The authors have read the ARRIVE guidelines, and the manuscript was prepared and revised according to the ARRIVE guidelines.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jin-Yuan Duan, PhD, Department of General Surgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 1519 Dongyue Avenue, Nanchang 330000, Jiangxi Province, China. duanjy2022@outlook.com
Received: June 30, 2024
Revised: October 12, 2024
Accepted: November 22, 2024
Published online: February 27, 2025
Processing time: 206 Days and 5.2 Hours
Abstract
BACKGROUND

The efficacy of various bariatric surgeries varies in reducing blood glucose levels. Given the distinct mechanisms and anatomical alterations associated with each procedure, it is crucial to compare their glycemic control outcomes. We hypothesize that proximal small intestinal bypass (PSIB) is superior in blood glucose reduction over Roux-en-Y gastric bypass (RYGB) and jejunoileal bypass (JIB).

AIM

To compare the effectiveness of PSIB, RYGB, and JIB in lowering blood glucose.

METHODS

Rats with streptozotocin-induced diabetes were randomly divided into PSIB, RYGB, JIB, and sham-operated groups. Body weight, food intake, fasting blood glucose level, oral glucose tolerance test, insulin tolerance test, liver enzymes, and blood lipids were measured.

RESULTS

Postoperatively, only the JIB group had a lower body weight compared to the sham group. The food intake of the rats in all three surgical groups was significantly less than that in the sham group. Fasting blood glucose was reduced in all surgical groups and was lower in the PSIB group than in the RYGB and JIB groups. Glucose tolerance and insulin sensitivity improved in all three surgical groups compared to the sham group, but the improvement appeared earliest in the PSIB group. At six weeks post-surgery, the PSIB group showed a reduction in alanine transaminase levels and maintained a normal lipid profile.

CONCLUSION

PSIB demonstrated excellent hypoglycemic effects in the early postoperative period, and had better efficacy than RYGB and JIB.

Keywords: Bariatric surgery; Diabetes; Glucose control; Proximal small intestinal bypass; Roux-en-Y gastric bypass; Jejunoileal bypass

Core Tip: Proximal small intestinal bypass (PSIB, approximately 60%) significantly improves glucose metabolism in streptozotocin-induced nonobese diabetic rats but does not reduce body weight. The glucose-lowering effect of PSIB may be independent of weight loss. PSIB has better glucose-lowering efficacy than classic Roux-en-Y gastric bypass and conventional jejunoileal bypass. Additionally, PSIB reduced blood glucose levels without causing abnormal liver enzyme levels or lipid profiles in the rats.