Residual Gastric Dilatation Interferes with Metabolic Improvements Following Sleeve Gastrectomy by Upregulating the Expression of Sodium-Glucose Cotransporter-1

  • Jun Xia
  • Qian He
  • Ming He
  • Guiwen Xu
  • Yizhou Tang
  • Yixing RenEmail author
Original Contributions



Sleeve gastrectomy (SG) is widely used in treating obesity because of significant weight loss and anti-diabetic effects, but there are still cases of long-term weight loss failure. Our aim was to explore the weight loss mechanism following SG in mice to learn how initial improvements in glucose metabolism are reversed in the long term.


C57/BL6 mice were divided into two groups, one undergoing SG and the other sham surgery. Body weight, gastric volume, blood glucose level, and the expression of sodium-glucose cotransporter 1 (SGLT1) were assessed at 2 weeks, 1 month, and 2 months after surgery.


The SG mice had reduced food intake and lost weight during the 30 days after surgery. However, food intake and weight recovered gradually and even surpassed the sham group after 30 days. SGLT1 expression decreased within 1 month after SG and then increased at 2 months. Although initial SGLT1 expression levels in the stomach were much lower than at intestinal sites, levels increased following surgery and then decreased. The gastric volume decreased after SG, but was significantly increased at 2 months, exceeding the gastric volume in the sham mice.


The metabolic benefits of SG are achieved through reduced gastrointestinal glucose absorption as evidenced by decreased expression of SGLT1 without bypassing the proximal intestine as in other forms of bariatric surgery. In addition, SGLT1 expression in the stomach may play a greater role in post-surgical metabolic effects, but further studies are needed.


Sleeve gastrectomy Obesity Weight loss Type 2 diabetes SGLT1 Glucose absorption Residual gastric volume 



We would like to acknowledge the assistance of John T. Cathey in language.


This research was supported by National Natural Science Foundation of China (81500396), Foundation of Sichuan Educational Committee (18CZ0023), Foundation of Sichuan Health Committee (18PJ496), Nanchong Government and North Sichuan Medical College Cooperation Project(18SXHZ0307), and Foundation of North Sichuan Medical College (CBY15-QD001).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All applicable institutional and/or national guidelines for the care and use of animals were followed.


  1. 1.
    Finucane MM, Stevens GA, Cowan MJ, et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9·1 million participants. Lancet. 2011;377:557–67.CrossRefGoogle Scholar
  2. 2.
    Spiegel H-U, Skawran S. From longitudinal gastric resection to sleeve gastrectomy--revival of a previously established surgical procedure. J Gastrointest Surg. 2011;15:219–28.CrossRefGoogle Scholar
  3. 3.
    Barzin M, Khalaj A, Motamedi MA, et al. Safety and effectiveness of sleeve gastrectomy versus gastric bypass: one-year results of Tehran obesity treatment study (TOTS). Gastroenterol Hepatol Bed Bench. 2016;9:S62–9.Google Scholar
  4. 4.
    Felsenreich DM, Langer FB, Kefurt R, et al. Weight loss, weight regain, and conversions to Roux-en-Y gastric bypass: 10-year results of laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2016;12:1655–62.CrossRefGoogle Scholar
  5. 5.
    Alexandrou A, Athanasiou A, Michalinos A, et al. Laparoscopic sleeve gastrectomy for morbid obesity: 5-year results. Am J Surg. 2015;209:230–4.CrossRefGoogle Scholar
  6. 6.
    Hans PK, Guan W, Lin S, et al. Long-term outcome of laparoscopic sleeve gastrectomy from a single center in mainland China. Asian J Surg. 2018;41:285–90.CrossRefGoogle Scholar
  7. 7.
    Weiner RA, Weiner S, Pomhoff I, et al. Laparoscopic sleeve gastrectomy--influence of sleeve size and resected gastric volume. Obes Surg. 2007;17:1297–305.CrossRefGoogle Scholar
  8. 8.
    Lauti M, Kularatna M, Hill AG, et al. Weight regain following sleeve gastrectomy-a systematic review. Obes Surg. 2016;26:1326–34.CrossRefGoogle Scholar
  9. 9.
    Chen L, Tuo B, Dong H. Regulation of intestinal glucose absorption by ion channels and transporters. Nutrients. 2016;8Google Scholar
  10. 10.
    Bhutta HY, Deelman TE, le Roux CW, et al. Intestinal sweet-sensing pathways and metabolic changes after Roux-en-Y gastric bypass surgery. Am J Physiol Gastrointest Liver Physiol. 2014;307:G588–93.CrossRefGoogle Scholar
  11. 11.
    Yan S, Sun F, Li Z, et al. Reduction of intestinal electrogenic glucose absorption after duodenojejunal bypass in a mouse model. Obes Surg. 2013;23:1361–9.CrossRefGoogle Scholar
  12. 12.
    Nguyen NQ, Debreceni TL, Bambrick JE, et al. Upregulation of intestinal glucose transporters after Roux-en-Y gastric bypass to prevent carbohydrate malabsorption. Obesity (Silver Spring). 2014;22:2164–71.CrossRefGoogle Scholar
  13. 13.
    Bosello O, Armellini F, Pelloso M, et al. Glucose tolerance in jejunoileal bypass for morbid obesity: a fifteen month follow-up. Diabete Metab. 1978;4:159–62.Google Scholar
  14. 14.
    Ackerman NB. Observations on the improvements in carbohydrate metabolism in diabetic and other morbidly obese patients after jejunoileal bypass. Surg Gynecol Obstet. 1981;152:581–6.Google Scholar
  15. 15.
    Rubino F, Marescaux J. Effect of duodenal-jejunal exclusion in a non-obese animal model of type 2 diabetes: a new perspective for an old disease. Ann Surg. 2004;239:1–11.CrossRefGoogle Scholar
  16. 16.
    Pal A, Rhoads DB, Tavakkoli A. Foregut exclusion disrupts intestinal glucose sensing and alters portal nutrient and hormonal milieu. Diabetes. 2015 [cited 2019 Mar 30]; 64:1941–50. Available from:
  17. 17.
    Kim M, Son YG, Kang YN, et al. Changes in glucose transporters, gluconeogenesis, and circadian clock after duodenal-jejunal bypass surgery. Obes Surg. 2015;25:635–41.CrossRefGoogle Scholar
  18. 18.
    Saeidi N, Nestoridi E, Kucharczyk J, et al. Sleeve gastrectomy and Roux-en-Y gastric bypass exhibit differential effects on food preferences, nutrient absorption and energy expenditure in obese rats. Int J Obes. 2012;36:1396–402.CrossRefGoogle Scholar
  19. 19.
    Donglei Z, Liesheng L, Xun J, et al. Effects and mechanism of duodenal-jejunal bypass and sleeve gastrectomy on GLUT2 and glucokinase in diabetic Goto-Kakizaki rats. Eur J Med Res. 2012;17:15.CrossRefGoogle Scholar
  20. 20.
    Daniel H, Zietek T. Taste and move: glucose and peptide transporters in the gastrointestinal tract. Exp Physiol. 2015;100:1441–50.CrossRefGoogle Scholar
  21. 21.
    Cavin JB, Couvelard A, Lebtahi R, et al. Differences in alimentary glucose absorption and intestinal disposal of blood glucose after Roux-en-Y gastric bypass vs sleeve gastrectomy. Gastroenterology. 2016;150:454.e–64.e. Scholar
  22. 22.
    Isbell JM, Tamboli RA, Hansen EN, et al. The importance of caloric restriction in the early improvements in insulin sensitivity after Roux-en-Y gastric bypass surgery. Diabetes Care. 2010;33:1438–42.CrossRefGoogle Scholar
  23. 23.
    Yoshikawa T, Inoue R, Matsumoto M, et al. Comparative expression of hexose transporters (SGLT1, GLUT1, GLUT2 and GLUT5) throughout the mouse gastrointestinal tract. Histochem Cell Biol. 2011;135:183–94.CrossRefGoogle Scholar
  24. 24.
    Vidal P, Ramón JM, Busto M, et al. Residual gastric volume estimated with a new radiological volumetric model: relationship with weight loss after laparoscopic sleeve gastrectomy. Obes Surg. 2014;24:359–63.CrossRefGoogle Scholar
  25. 25.
    Deguines J-B, Verhaeghe P, Yzet T, et al. Is the residual gastric volume after laparoscopic sleeve gastrectomy an objective criterion for adapting the treatment strategy after failure? Surg Obes Relat Dis. 2013;9:660–6.CrossRefGoogle Scholar
  26. 26.
    Zhang X, Yu B, Yang D, et al. Gastric volume reduction is essential for the remission of type 2 diabetes mellitus after bariatric surgery in nonobese rats. Surg Obes Relat Dis. 2016;12:1569–76.CrossRefGoogle Scholar
  27. 27.
    Röder PV, Geillinger KE, Zietek TS, et al. The role of SGLT1 and GLUT2 in intestinal glucose transport and sensing. PLoS One. 2014;9:e89977.CrossRefGoogle Scholar
  28. 28.
    Dyer J, Wood IS, Palejwala A, et al. Expression of monosaccharide transporters in intestine of diabetic humans. Am J Physiol Gastrointest Liver Physiol. 2002;282:G241–8.CrossRefGoogle Scholar
  29. 29.
    Lutz TA, Bueter M. The use of rat and mouse models in bariatric surgery experiments. Front Nutr. 2016;3:25. ReviewCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.School of Clinical MedicineNorth Sichuan Medical CollegeNanchongPeople’s Republic of China
  2. 2.Department of General Surgery, and Institute of Hepato-Biliary-Pancreas and Intestinal DiseaseAffiliated Hospital of North Sichuan Medical CollegeNanchongPeople’s Republic of China

Personalised recommendations