Are SADI-S and BPD/DS bariatric procedures identical twins or distant relatives? – A case report

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Given the common anatomical features and similar short-term weight loss outcomes, Biliopancreatic Diversion with Duodenal Switch (BPD/DS) and Single-Anastomosis Duodenoileal bypass with Sleeve gastrectomy (SADI-S) are considered identical bariatric procedures, apart from technical complexity being lower for SADI-S. In the absence of prospective randomized trials or long-term comparative studies the rationale for choosing between procedures is hampered. Post-bariatric hormonal profiles could contribute to understand the underlying mechanisms and potentially be used as a decision aid when choosing between procedures. The main aim of this study was to compare the outcomes of BPD/DS and SADI-S, in genetically identical individuals exposed to similar environmental factors. Two identical twin (T) female patients, one submitted to BPD/DS (T_BPD/DS) and another to SADIS-S (T_SADI-S) were followed up to one year after surgery. Before surgery and at 3, 6 and 12 months after surgery, both patients underwent mixed meal tolerance tests (MMTT) to evaluate postprandial glucose, glucagon and GLP-1 response. In addition, 3 months after surgery, glucose dynamics were assessed using a Flash Glucose Monitoring (FGM) system for 14 days. The percentage of total weight loss (%TWL) was higher for T_BPD/DS compared to T_SADI-S (34.03 vs 29.03 %). During MMTT, T_BPD/DS presented lower glucose, glucagon, insulin and C-peptide excursions at all timepoints when compared to SADI-S; along with a greater percentage of time within the low glucose range (55.97 vs 39.93 %) and numerically lower glucose variability indexes on FGM (MAG change:0.51 vs 0.63 mmol/l×h−1). In patients with the same genetic background, BPD/DS was shown to result in greater weight loss than SADI-S. The differences in glucose and enteropancreatic hormone profiles observed after BPD/DS and SADI-S suggest that different mechanisms underlie weight loss.

TidsskriftObesity Research and Clinical Practice
Udgave nummer2
Sider (fra-til)166-170
StatusUdgivet - 2023

Bibliografisk note

Funding Information:
UMIB research is funded by Fundação para a Ciência e Tecnologia (FCT-Portugal, UIDB/00215/2020, UIDP/00215/2020, and LA/P/0064/2020 ). Novo Nordisk Foundation Center for Basic Metabolic Research is an independent Research Center, based at the University of Copenhagen, Denmark and partially funded by an unconditional donation from the Novo Nordisk Foundation , Denmark ( ) (Grant number NNF18CC0034900 ). CBL is supported by a research grant from the Danish Diabetes Academy (grant-ID PhD013-20 ), which is funded by the Novo Nordisk Foundation, Denmark , grant nr. NNF17SA0031406 ; and by a grant from the “la Caixa” Foundation , Spain (ID 100010434 , fellowship code LCF/BQ/EU21/11890081).

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