A perspective on metabolic surgery from a gastroenterologist.

Area of Science:

• Endocrinology
• Gastroenterology
• Metabolic Medicine

Background:

• Type 2 diabetes (T2D) and obesity are significant global health challenges.
• The prevalence of diabetes mellitus is 8.8% worldwide.
• Interventional diabetology and obesitology offer new treatment avenues.

Purpose of the Study:

• To review the roles of metabolic surgery and endoscopic treatments in managing T2D and obesity.
• To explore the mechanisms by which these interventions improve glycemic control and weight loss.
• To emphasize the significance of the small intestine in metabolic homeostasis.

Main Methods:

• Review of metabolic surgeries: Roux-en-Y gastric bypass, sleeve gastrectomy, gastric banding, biliopancreatic diversion.
• Analysis of endoscopic treatments: intra-gastric balloon, duodenal-jejunal bypass liner (DJBL).
• Examination of gastrointestinal anatomical changes and their impact on hormones, microbiota, and inflammatory markers.

Main Results:

• Metabolic surgeries and DJBL demonstrate varying glucose-lowering and weight loss effects.
• Interventions modulate gut hormones (foregut and hindgut), improving glycemic homeostasis.
• Procedures alter inflammatory cytokines, appetite regulation via nutrient sensing, and gut microbiota.

Conclusions:

• The small intestine plays a critical role in glucose homeostasis, as evidenced by metabolic surgery and DJBL.
• Modulating gut hormones and nutrient sensing in the small intestine is key to managing T2D and obesity.
• Future strategies may involve removing diabetogenic/obesogenic factors from the duodenum/jejunum.