Ileum excision partially reverses improvement of glucose metabolism in diabetic rats after biliopancreatic diversion with duodenal switch

Background: Bile acids can stimulate the secretion of glucagon-like peptide-1 (GLP-1) and be mostly reabsorbed in the ileum. Objectives: We aimed to investigate whether ileum excision could reverse the glucose improvement after biliopancreatic diversion with duodenal switch (BPD/DS). Setting: Peking Union Medical College Hospital. Methods: Thirty diabetic rats were randomly divided into the BPD/DS group, BPD/DS plus ileectomy (BDI) group, and control group. The fasting blood glucose, bile acids, and glucagon-like peptide-1(GLP-1) levels in plasma samples were analyzed. Results: In postoperative week 20, the fasting blood glucose level in the BDI group was significantly higher than that in the BPD/DS group (11.5 +/- 1.4 mmol/L versus 7.6 +/- 1.0 mmol/L, P < .001), and the AUC OGTT value was also significantly higher than that in the BPD/DS group (2186.1 +/- 237.2 mmol/L min versus 1551.2 +/- 136.9 mmol/L min, P < .001). The plasma level of bile acids in the BDI group was lower than that in the BPD/DS group (P P = .012) and was not significantly different from that in the control group (P P = .629). The plasma level of GLP-1 in the BDI group was lower than that in the BPD/DS group (P P = .009) and was not significantly different from that in the control group (P P = .530). Moreover, the intestinal TGR5 expression in the BDI group was significantly lower than that in the BPD/DS group (P P < .001). Conclusions: The results show that excision of the ileum can partially reverse the improvement in glucose metabolism after BPD/DS. (Surg Obes Relat Dis 2024;20:962-969.) (c) 2024 Published by Elsevier Inc. on behalf of American Society for Metabolic and Bariatric Surgery.