Duodenal Switch Imperative for Bariatric Surgery Success

The duodenal switch component of biliopancreatic diversion with duodenal switch (BPD/DS) is the key to persistent reductions in body weight and body fat, according to a new study.

Researchers at the Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ; Canada) conducted a murine study to examine the contributions of the two main components of BPD/DS, sleeve gastrectomy (SG) and duodenal switch (DS), on energy balance changes in male Wistar rats rendered obese with a high-fat diet. Three different bariatric procedures (BPD/DS, SG alone, and DS) and three sham surgeries were performed to examine the mechanisms underlying the body weight and fat loss after BPD.

The results showed that all three bariatric surgeries resulted in a transient reduction in food intake. SG per se induced a delay in body weight gain; BPD/DS and DS led to a noticeable gut malabsorption and a reduction in body weight and fat gains, along with elevated energy expenditure. They also reduced the volume, oxidative metabolism, and expression of thermogenic genes in interscapular brown adipose tissue (iBAT), a heat-producing tissue whose activity is mainly controlled by the sympathetic nervous system. The study was published on February 03, 2015, in Endocrinology.

“The results of this study suggest that the DS component of the BPD/DS, which led to a reduction in digestible energy intake while sustaining energy expenditure, plays a key role in the improvement in the metabolic profile,” concluded lead author Denis Richard, PhD, and colleagues. “More than other bariatric surgery, biliopancreatic diversion with duodenal switch is associated with significant weight loss and metabolic improvements, such as normalization of plasma glucose, insulin triglycerides, and free fatty acids.”

In BPD/DS both the duodenum and the small intestine are divided, and the remaining portion of the small intestine is attached to a short duodenal section next to the stomach, which is left largely intact. The remaining section of the duodenum is connected to the pancreas and gallbladder close to the large intestine. The surgery is demanding and has a higher complication rate than other bariatric procedures, and is therefore performed far less often.

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Institut universitaire de cardiologie et de pneumologie de Québec