Proximal Jejunal Bypass Improves the Outcome of Gastric Clip in Patients with Obesity and Type 2 Diabetes Mellitus

Abstract

BackgroundLaparoscopic gastric clip (GC), a novel pure restrictive procedure, is a safe and effective treatment for morbid obesity. However, whether adding a proximal jejunal bypass (PJB) to this procedure might increase the efficacy is unknown.MethodsOutcomes of 74 (43 women and 31male) obese patients who had undergone PJB-GC (41) or GC (33) for the treatment of type 2 diabetes mellitus (T2D) with 1\xa0year follow-up were assessed. GC consists of creating a transverse gastric partition with a metallic clip. PJB consists of a jejuno-ileostomy between 20 and 320\xa0cm distal to the ligament of Treitz. Postoperative body mass index (BMI) reduction, total weight loss (TWL), and remission rates of T2D were evaluated.ResultsThe preoperative clinical characters in both groups were similar. The mean operative time was significantly longer in the PJB-GC group than in the GC group. At 24\xa0months after surgery, the BMI was lower (32.5\u2009±\u20096.2 vs. 37.0\u2009±\u20095.9\xa0kg/m2, p\u2009=\u20090.002) and weight loss higher in PJB-GC than GC (TWL 31.3\u2009±\u200914.8 vs. 23.5\u2009±\u200910.4%, p\u2009=\u20090.011). Remission of T2D was greater in the PJB-GC group (90.2 vs. 57.2%; p\u2009<\u20090.001).ConclusionsIn this study, PJB-GC was superior to GC in weight loss and T2D remission at 1 and 2\xa0years after surgery. Adding PJB to GC increased the effect of weight loss and diabetic control.