{
  "abstract": "Metabolic and bariatric procedures improve glycaemic control through both weight-dependent and weight-independent mechanisms. Sleeve gastrectomy induces weight loss through gastric restriction with some hormonal changes, whereas duodeno–ileal (DI) bypass promotes weight loss by altering nutrient flow and absorption with more pronounced hormonal modulation. The combination of these components, as performed in single-anastomosis DI bypass with sleeve gastrectomy (SADI), results in substantial metabolic improvement; however, the relative contributions of each component remain incompletely understood. The sutureless neodymium magnet anastomosis procedure (SNAP), an endoscopic–laparoscopic technique that creates a sutureless duodeno–ileostomy, reproduces the intestinal diversion component of SADI without gastric resection, providing a unique human model to study these mechanisms. In this prospective study of 14 patients with obesity and type 2 diabetes who underwent SNAP DI, haemoglobin A1c (HbA1c) reduced from 8.3±1.3% to 6.4±0.6% at 12 months (p<0.0001). Postprandial bile acids increased at 1 month, followed by glucagon-like peptide-1 (GLP-1) and peptide YY (PYY) increases at 12 months. Early hormonal responses predicted greater glycaemic improvement.",
  "authors": [
    {
      "affiliations": [
        "Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital Department of Medicine, Boston, Massachusetts, USA",
        "Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Pichamol Jirapinyo"
    },
    {
      "affiliations": [
        "Department of Surgery, Hospital Aleman, Buenos Aires, Buenos Aires, Argentina"
      ],
      "name": "Francisco Schlottmann"
    },
    {
      "affiliations": [
        "Department of Surgery, Hospital Aleman, Buenos Aires, Buenos Aires, Argentina"
      ],
      "name": "Rudolf Buxhoeveden"
    },
    {
      "affiliations": [
        "Department of Surgery, Emerson Hospital, Concord, Massachusetts, USA"
      ],
      "name": "David Lautz"
    },
    {
      "affiliations": [
        "Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital Department of Medicine, Boston, Massachusetts, USA",
        "Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Marvin Ryou"
    },
    {
      "affiliations": [
        "Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital Department of Medicine, Boston, Massachusetts, USA",
        "Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Christopher C Thompson"
    }
  ],
  "title": "Metabolic mechanisms of duodeno–ileal diversion: early bile acid and incretin signalling predict glycaemic outcomes",
  "uid": "a00670cd-5065-5267-bdb8-dc30e0cdbe1d"
}