title: Duodenal diverted sleeve gastrectomy with ileal interposition does not cause biliary salt malabsorption.
abstract: BACKGROUND
  Duodenal diverted sleeve gastrectomy with ileal interposition (DDSG-II) is a bariatric-metabolic operation designed to treat type 2 diabetes mellitus (T2DM). It is restrictive (SG) but also acts on the small bowel with functional effects. The objective of the present study was to investigate whether or not it is also a malabsorptive operation.
  
  
  METHODS
  Twelve obese patients (9 female and 3 male) affected by T2DM had DDSG-II. Follow-up was every 3 months, and the results after 1 year are reported here. Clinical conditions, related to diabetes and malnutrition, changes in weight, body mass index, fasting glucose plasma levels, HbA1c (glycated hemoglobin %), basal insulin, vitamin B12, folic acid, vitamin D, total proteins, albumin, and hemoglobin were recorded. Basal plasma levels of FGF19 (pg/mL) and of 7α-hydroxy-4-cholesten-3-one (C4) (μg/dL) were also determined for the diagnosis of biliary salt malabsorption. The results were expressed as mean±SEM, and the differences between times compared by the Mann Whitney U test; P<.05 was considered significant.
  
  
  RESULTS
  After 1 year, all patients had a significant weight loss (-33.2±3 kg) with T2DM remission according to the American Diabetes Association criteria (11), criteria. No significant changes in total proteins, albumin, hemoglobin, and vitamins (B6, B12, and D) were detected. C4 did not change after the operation (2±.5 µg/dL versus 1.6±.5 µg/dL), whereas FGF19 significantly increased (from 85±11.2 pg/mL to 166.4±28.2 pg/mL, P<.04). Only 2 patients had mild symptoms of malabsorption.
  
  
  CONCLUSIONS
  DDSG-II is effective for treatment of T2DM obese patients, increases the enterokine FGF19, and does not cause biliary salt malabsorption.
authors.affiliation: II Unit of General Surgery, Department of Biomedical Sciences, Luigi Sacco Hospital, University of Milan, Milan, Italy. Electronic address: diego.foschi@unimi.it.
authors.forename: Diego A
authors.initials: DA
authors.lastname: Foschi
authors.affiliation: II Unit of General Surgery, Department of Biomedical Sciences, Luigi Sacco Hospital, University of Milan, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Rizzi
authors.affiliation: II Unit of General Surgery, Department of Biomedical Sciences, Luigi Sacco Hospital, University of Milan, Milan, Italy.
authors.forename: Igor
authors.initials: I
authors.lastname: Tubazio
authors.affiliation: II Unit of General Surgery, Department of Biomedical Sciences, Luigi Sacco Hospital, University of Milan, Milan, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Conti
authors.affiliation: Unit of Endocrinology, Department of Biomedical Sciences, Luigi Sacco Hospital, University of Milan, Milan, Italy.
authors.forename: Tarcisio
authors.initials: T
authors.lastname: Vago
authors.affiliation: Unit of Endocrinology, Department of Biomedical Sciences, Luigi Sacco Hospital, University of Milan, Milan, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Bevilacqua
authors.affiliation: Department of Health Sciences, University of Milano-Bicocca, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Magni
authors.affiliation: Department of Health Sciences, University of Milano-Bicocca, Milan, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Del Puppo
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002783:Cholestenones / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000378:metabolism* / Q000601:surgery*; D005260:Female; D005346:Fibroblast Growth Factors / Q000378:metabolism; D005743:Gastrectomy; D006801:Humans; D007408:Intestinal Absorption / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000378:metabolism / Q000601:surgery*; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D002783:Cholestenones; C117476:FGF19 protein, human; C002656:7 alpha-hydroxy-4-cholesten-3-one; D005346:Fibroblast Growth Factors
keywords: C4; FGF19; Ileal interposition; Malabsorption; T2DM