A systematic review and meta-analysis of the effect of Billroth reconstruction on type 2 diabetes

A new perspective on old surgical methods

Yeongkeun Kwon, Hyun Jung Kim, Emanuele Lo Menzo, Sungsoo Park, Samuel Szomstein, Raul J. Rosenthal

Research output: Contribution to journalReview article

7 Citations (Scopus)

Abstract

Background Studies have reported that Billroth II (BII) reconstruction after subtotal gastrectomy for cancer or intractable ulcers can more effectively improve type 2 diabetes mellitus (T2D) than Billroth I (BI) reconstruction by allowing patients to achieve normoglycemia without or with lower doses of diabetes medications. Thus, we conducted a systematic review and meta-analysis of studies to assess the effect of Billroth techniques on postoperative T2D status and identify the clinical predictors of amelioration. Methods The MEDLINE and EMBASE databases and the Cochrane Central Register of Controlled Trials were searched for studies using a list of keywords. Moreover, reference lists from relevant review articles were searched. We included studies comparing BI with BII reconstruction as well as those with available outcome data for postoperative T2D status. Of the 52 potentially relevant studies, 8 met the inclusion criteria. Data were combined using a fixed- or random-effects model. Results Compared with the BI group, the relative risk for postoperative T2D remission and amelioration in the BII group was 1.49 (95% confidence interval [CI], 1.01 to 2.19) and 1.31 (95% CI, 1.11 to 1.54), respectively. Patients who achieved amelioration had a higher body mass index than those who did not (weighted mean difference,.88 kg/m2; 95% CI,.38 to 1.37) and shorter duration of diabetes (weighted mean difference, -0.40; 95% CI, -0.23 to -.70) at baseline. Conclusions BII reconstruction after subtotal gastrectomy for cancer or intractable ulcers more effectively improved T2D than BI reconstruction. Thus, BII reconstruction may provide a treatment strategy for diabetic patients with gastric cancer or ulcers and enable metabolic surgery for nonobese patients.

Original languageEnglish
Pages (from-to)1386-1395
Number of pages10
JournalSurgery for Obesity and Related Diseases
Volume11
Issue number6
DOIs
Publication statusPublished - 2015 Nov 1

Fingerprint

Gastroenterostomy
Type 2 Diabetes Mellitus
Meta-Analysis
Confidence Intervals
Gastrectomy
Ulcer
Bariatric Surgery
Stomach Ulcer
MEDLINE
Stomach Neoplasms
Neoplasms
Body Mass Index
Databases

Keywords

  • Billroth
  • Gastric cancer
  • Metabolic surgery
  • Subtotal gastrectomy
  • Type 2 diabetes

ASJC Scopus subject areas

  • Surgery

Cite this

A systematic review and meta-analysis of the effect of Billroth reconstruction on type 2 diabetes : A new perspective on old surgical methods. / Kwon, Yeongkeun; Jung Kim, Hyun; Lo Menzo, Emanuele; Park, Sungsoo; Szomstein, Samuel; Rosenthal, Raul J.

In: Surgery for Obesity and Related Diseases, Vol. 11, No. 6, 01.11.2015, p. 1386-1395.

Research output: Contribution to journalReview article

Kwon, Yeongkeun ; Jung Kim, Hyun ; Lo Menzo, Emanuele ; Park, Sungsoo ; Szomstein, Samuel ; Rosenthal, Raul J. / A systematic review and meta-analysis of the effect of Billroth reconstruction on type 2 diabetes : A new perspective on old surgical methods. In: Surgery for Obesity and Related Diseases. 2015 ; Vol. 11, No. 6. pp. 1386-1395.
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abstract = "Background Studies have reported that Billroth II (BII) reconstruction after subtotal gastrectomy for cancer or intractable ulcers can more effectively improve type 2 diabetes mellitus (T2D) than Billroth I (BI) reconstruction by allowing patients to achieve normoglycemia without or with lower doses of diabetes medications. Thus, we conducted a systematic review and meta-analysis of studies to assess the effect of Billroth techniques on postoperative T2D status and identify the clinical predictors of amelioration. Methods The MEDLINE and EMBASE databases and the Cochrane Central Register of Controlled Trials were searched for studies using a list of keywords. Moreover, reference lists from relevant review articles were searched. We included studies comparing BI with BII reconstruction as well as those with available outcome data for postoperative T2D status. Of the 52 potentially relevant studies, 8 met the inclusion criteria. Data were combined using a fixed- or random-effects model. Results Compared with the BI group, the relative risk for postoperative T2D remission and amelioration in the BII group was 1.49 (95{\%} confidence interval [CI], 1.01 to 2.19) and 1.31 (95{\%} CI, 1.11 to 1.54), respectively. Patients who achieved amelioration had a higher body mass index than those who did not (weighted mean difference,.88 kg/m2; 95{\%} CI,.38 to 1.37) and shorter duration of diabetes (weighted mean difference, -0.40; 95{\%} CI, -0.23 to -.70) at baseline. Conclusions BII reconstruction after subtotal gastrectomy for cancer or intractable ulcers more effectively improved T2D than BI reconstruction. Thus, BII reconstruction may provide a treatment strategy for diabetic patients with gastric cancer or ulcers and enable metabolic surgery for nonobese patients.",
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T2 - A new perspective on old surgical methods

AU - Kwon, Yeongkeun

AU - Jung Kim, Hyun

AU - Lo Menzo, Emanuele

AU - Park, Sungsoo

AU - Szomstein, Samuel

AU - Rosenthal, Raul J.

PY - 2015/11/1

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N2 - Background Studies have reported that Billroth II (BII) reconstruction after subtotal gastrectomy for cancer or intractable ulcers can more effectively improve type 2 diabetes mellitus (T2D) than Billroth I (BI) reconstruction by allowing patients to achieve normoglycemia without or with lower doses of diabetes medications. Thus, we conducted a systematic review and meta-analysis of studies to assess the effect of Billroth techniques on postoperative T2D status and identify the clinical predictors of amelioration. Methods The MEDLINE and EMBASE databases and the Cochrane Central Register of Controlled Trials were searched for studies using a list of keywords. Moreover, reference lists from relevant review articles were searched. We included studies comparing BI with BII reconstruction as well as those with available outcome data for postoperative T2D status. Of the 52 potentially relevant studies, 8 met the inclusion criteria. Data were combined using a fixed- or random-effects model. Results Compared with the BI group, the relative risk for postoperative T2D remission and amelioration in the BII group was 1.49 (95% confidence interval [CI], 1.01 to 2.19) and 1.31 (95% CI, 1.11 to 1.54), respectively. Patients who achieved amelioration had a higher body mass index than those who did not (weighted mean difference,.88 kg/m2; 95% CI,.38 to 1.37) and shorter duration of diabetes (weighted mean difference, -0.40; 95% CI, -0.23 to -.70) at baseline. Conclusions BII reconstruction after subtotal gastrectomy for cancer or intractable ulcers more effectively improved T2D than BI reconstruction. Thus, BII reconstruction may provide a treatment strategy for diabetic patients with gastric cancer or ulcers and enable metabolic surgery for nonobese patients.

AB - Background Studies have reported that Billroth II (BII) reconstruction after subtotal gastrectomy for cancer or intractable ulcers can more effectively improve type 2 diabetes mellitus (T2D) than Billroth I (BI) reconstruction by allowing patients to achieve normoglycemia without or with lower doses of diabetes medications. Thus, we conducted a systematic review and meta-analysis of studies to assess the effect of Billroth techniques on postoperative T2D status and identify the clinical predictors of amelioration. Methods The MEDLINE and EMBASE databases and the Cochrane Central Register of Controlled Trials were searched for studies using a list of keywords. Moreover, reference lists from relevant review articles were searched. We included studies comparing BI with BII reconstruction as well as those with available outcome data for postoperative T2D status. Of the 52 potentially relevant studies, 8 met the inclusion criteria. Data were combined using a fixed- or random-effects model. Results Compared with the BI group, the relative risk for postoperative T2D remission and amelioration in the BII group was 1.49 (95% confidence interval [CI], 1.01 to 2.19) and 1.31 (95% CI, 1.11 to 1.54), respectively. Patients who achieved amelioration had a higher body mass index than those who did not (weighted mean difference,.88 kg/m2; 95% CI,.38 to 1.37) and shorter duration of diabetes (weighted mean difference, -0.40; 95% CI, -0.23 to -.70) at baseline. Conclusions BII reconstruction after subtotal gastrectomy for cancer or intractable ulcers more effectively improved T2D than BI reconstruction. Thus, BII reconstruction may provide a treatment strategy for diabetic patients with gastric cancer or ulcers and enable metabolic surgery for nonobese patients.

KW - Billroth

KW - Gastric cancer

KW - Metabolic surgery

KW - Subtotal gastrectomy

KW - Type 2 diabetes

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