Loop vs Roux-En-Y DJB-SG Induced More Weight Loss in Type 2 Diabetes

Gastric bypass surgery.
Gastric bypass surgery.
Researchers compared the short-term efficacy and safety of loop vs Roux-en-Y duodenojejunal bypass with sleeve gastrectomy in type 2 diabetes.

Among patients with type 2 diabetes (T2D) undergoing bariatric surgery, loop duodenojejunal bypass with sleeve gastrectomy (DJB-SG) was associated with more weight loss compared with Roux-en-Y DJB-SG, according to study findings published in Surgery for Obesity and Related Diseases.

Patients (N=96) with T2D and a BMI between 27.5 and 40 kg/m2 undergoing bariatric surgery at the First Affiliated Hospital of Nanjing Medical University in China in 2020 were recruited for the study. Participants were randomly assigned 1:1 to receive loop (n=48) or Roux-en-Y (n=48) DJB-SG. The primary endpoint was T2D complete or partial remission, defined as maintaining glycated hemoglobin (HbA1C) at less than 6.0% or less than 6.5% for 1 year without glucose-lowering medications, respectively.

The loop and Roux-en-Y cohorts had a mean age of 36.94±8.76 and 36.85±7.42 years, the female:male ratio was 32:16 and 32:16, BMI was 33.68±3.46 and 33.43±3.47 kg/m2, HbA1C was 8.78%±1.18% and 8.93%±1.26%, and the duration of T2D was 3.16±2.65 and 4.22±3.96 years, respectively.

The loop DJB-SG procedure was shorter (mean, 117.72 vs 139.60 min; P <.0001) and less costly (mean, ¥51,683.56 vs ¥56,742.98; P <.0001) than Roux-en-Y DJB-SG.

Complete and partial T2D remission at 1 year was observed among 34 and 6 loop DJB-SG recipients and 31 and 9 Roux-en-Y DJB-SG recipients (P =.5679).

At 1 year, both cohorts were associated with significant improvements to weight, BMI, HbA1C, fasting blood glucose, total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and hypertension rate compared with baseline (all P <.05), and the loop DJB-SG was also associated with significantly improved uric acid levels (P <.05).

Compared between groups, loop DJB-SG was associated with lower BMI (mean, 23.16 vs 25.01 kg/m2; P =.0007) and more total (mean, 30.85% vs 26.11%; P =.0026) and excess (mean, 122.84% vs 107.02%; P =.0454) weight loss, respectively.

Significantly more patients were anemic at 1 year compared with baseline (P <.05), and significant changes to hemoglobin and iron were observed in both groups (P <.05). The loop DJB-SG was associated with significant changes to calcium, folic acid, and vitamin B12 (all P <.05) and Roux-en-Y DJB-SG with changes to albumin (P <.05), compared with baseline. Compared between groups, loop DJB-SG recipients had lower folic acid levels at 1 year (mean, 21.25 vs 32.81 nmol/L; P <.0001).

Study limitations included the single-center design, small sample size, and a short follow-up duration. It remains unclear whether loop or Roux-en-Y DJB-SG procedures may be associated with long-term nutritional detriments.

The study authors concluded that “loop DJB-SG was better than Roux-en-Y DJB-SG regarding medical expense, surgical complexity, and weight loss, while it had similar effect on diabetes remission, metabolic resolution, surgical safety, postoperative malnutrition and gastrointestinal disorders to Roux-en-Y DJB-SG.”


Lin S, Li C, Shen J, Guan W, Liang H. Loop versus Roux-en-Y duodenojejunal bypass with sleeve gastrectomy for type 2 diabetes mellitus: short-term outcomes of a single-center randomized controlled trial. Surg Obes Relat Dis. Published online July 13, 2022. doi:10.1016/j.soard.2022.07.003