The effect of laparoscopic gastric banding surgery on plasma levels of appetite-control, insulinotropic, and digestive hormones.
BACKGROUND
We hypothesized that laparoscopic adjustable gastric banding (LAGB) reduces weight and modulates ghrelin production, but largely spares gastrointestinal endocrine function. To examine this hypothesis, we determined plasma concentrations of appetite-control, insulinotropic, and digestive hormones in relation to LAGB.


METHODS
Twenty-four patients undergoing LAGB were prospectively enrolled. Body mass index (BMI) was measured and blood samples obtained at baseline and 6 and 12 months post-surgery. Plasma concentrations of leptin, acylated and total ghrelin, pancreatic polypeptide (PP), insulin, glucose-dependent insulinotropic peptide (GIP), active glucagon-like peptide-1 (GLP-1), gastrin, and pepsinogens I and II were measured using enzyme-linked immunoassays.


RESULTS
Median percent excess weight loss (%EWL) over 12 months was 45.7% with median BMI decreasing from 43.2 at baseline to 33.8 at 12 months post-surgery (p < 0.001). Median leptin levels decreased from 19.7 ng/ml at baseline to 6.9 ng/ml at 12 months post-surgery (p < 0.001). In contrast, plasma levels of acylated and total ghrelin, PP, insulin, GIP, GLP-1, gastrin, and pepsinogen I did not change in relation to surgery (p > 0.05). Pepsinogen II levels were significantly lower 6 months after LAGB but returned to baseline levels by 12 months.


CONCLUSIONS
LAGB yielded substantial %EWL and a proportional decrease in plasma leptin. Our results support the hypothesis that LAGB works in part by suppressing the rise in ghrelin that normally accompanies weight loss. Unchanged concentrations of insulinotropic and digestive hormones suggest that gastrointestinal endocrine function is largely maintained in the long term.
Shak
Joshua R
JR
Department of Medicine, NYU School of Medicine, New York, NY, USA.
Roper
Jatin
J
Perez-Perez
Guillermo I
GI
Tseng
Chi-hong
CH
Francois
Fritz
F
Gamagaris
Zoi
Z
Patterson
Carlie
C
Weinshel
Elizabeth
E
Fielding
George A
GA
Ren
Christine
C
Blaser
Martin J
MJ
D000328:Adult; D001069:Appetite Regulation / Q000502:physiology; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D005768:Gastrointestinal Hormones / Q000097:blood*; D015391:Gastroplasty; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000097:blood* / Q000601:surgery*; D036361:Peptide Hormones / Q000097:blood*; D011446:Prospective Studies; D013997:Time Factors; D015431:Weight Loss / Q000502:physiology
D005768:Gastrointestinal Hormones; D036361:Peptide Hormones