Sleeve gastrectomy and Roux-en-Y gastric bypass in the treatment of type 2 diabetes. Two-year results from a Swedish multicenter randomized controlled trial.

BACKGROUND: Obesity is a world-wide epidemic and it is a risk factor for type 2 diabetes (T2D). Few randomized controlled studies have compared the 2 most common surgical procedures, Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in the treatment of obese patients with T2D. OBJECTIVES: To compare diabetes remission rates (glycosylated hemoglobin ≤6.0%, without diabetes medications) in obese T2D patients (body mass index, 35-50) undergoing RYGB or SG. SETTING: Three University Hospital clinics and 1 Regional Hospital in Sweden. METHODS: Forty-nine patients with T2D were included. Twenty-five were randomized to RYGB and 24 to SG. There was no difference between groups regarding patient characteristics, duration of T2D, overall usage of antidiabetic medications, or glycosylated hemoglobin levels. All patients (100%) completed 1-year follow-up and 47 (95.9%) 2-year follow-up. RESULTS: Remission of T2D was not significantly different between the RYGB and SG, reaching 44% and 46% (n = 25 and n = 24, respectively, P = .897, power = .80) at 1 year, and 48% and 55% (n = 25 and n = 22, respectively, P = .654) at 2 years of follow-up. Similarly, mean glycosylated hemoglobin was improved in both groups at 1 and 2 years, with no significant differences between the groups (RYGB baseline versus 1 yr; mean ± standard deviation: 7.9 ± 1.5 versus 5.8 ± .6%, P < .0001; versus 2 yr: 5.9 ± .7%, P < .0001; SG baseline versus 1 yr: 8.2 ± 1.9 versus 5.9 ± .7%, P < .0001; versus 2 yr: 5.9 ± 1.1%, P < .0001). Total weight loss was not different but percentage excess weight loss was higher after RYGB compared with SG both at 1 and 2 years; mean ± standard deviation: 78 ± 22 versus 60 ± 22%, and 76 ± 24 versus 54 ± 21%, respectively (P < .01 for both). Waist circumference also decreased significantly more in the RYGB group. CONCLUSIONS: Despite superior excess weight loss after RYGB, T2D remission rates did not differ significantly between RYGB and SG after 2 years. Long-term follow-up data are needed to define the role of SG in the treatment of patients with obesity and T2D.

A preventive effect of unfractionated heparin on post-ERCP pancreatitis is suggested by positive effects on laboratory markers.

BACKGROUND/AIMS: Heparin has anti-inflammatory properties. Serum tests after ERCP might serve as surrogate markers for inflammatory reactions. The aims were to study effects of low-dose unfractionated heparin on post-ERCP laboratory tests and on safety. METHODOLOGY: The design was prospective, randomized, double-blind, placebo-controlled. Eighty-nine patients were randomized to 5000 IE Heparin (0.2 ml of 25000 IE) or 0.2 ml 0.9% NaCL given s.c. 4h before and 4h and 18h after ERCP. Amylase, AST, ALT, CRP and leucocyte count were analyzed at these times and also after 48h. Adverse events were registered. RESULTS: Significant increase was observed after 18h in the placebo group (n=44) for amylase (mean: 0.66 microkat/l, SD:0.8 vs. mean: 4.56 microkat/l, SD:9.9, p = 0.011), AST (mean: 1.37 microkat/l, SD: 1.5 vs. mean: l.96 microkat/l, SD:2.1, p = 0.049) and ALT (mean: 2.42 microkat/l, SD:2.7 vs. mean: 2.91, SD: 2.9% kat/l, p = 0.042). Corresponding elevations were not seen in the heparin group (n=41): p = 0.371, 0.395 and 0.25 respectively. Leucocyte count elevation was higher with longer duration in the placebo group. Mild pancreatitis occurred in 4.7% (placebo: 3, heparin: (1) and 4/89 (placebo: 2, heparin:(2) were excluded due to minor bleeding after the first injection. CONCLUSIONS: Low-dose heparin reduces the characteristic rise in laboratory tests seen after ERCP. Larger studies with acute pancreatitis as the end-point are justified.