SLIM
This is an ongoing project.
Scientific Report
The SLIM Project (Swiss Multicenter Randomized Controlled Trial on Different Limb Lengths in Gastric Bypass Surgery), initiated by Prof. Ralph Peterli in 2020, investigates the mechanisms behind the varying responses to bariatric surgery. Our research group led by Prof. Marco Bueter at the University Hospital Zurich is closely collaborating with Prof. Peterli to conduct this study, contributing to its execution and scientific analysis. The project seeks to understand why some patients experience more significant metabolic improvements than others despite undergoing the same procedure.
While bariatric surgery, particularly the laparoscopic proximal Roux-en-Y gastric bypass (LRYGB), is effective in achieving sustained weight loss and alleviating comorbidities like type 2 diabetes mellitus (T2DM), the reasons for differential outcomes remain unclear. This study focuses on exploring the metabolic and hormonal effects of the procedure, emphasizing the role of small bowel bypass length in improving outcomes, while acknowledging the potential risks of nutrient deficiencies.
The SLIM trial, which is well-powered, will address gaps left by previous research (like the inability to assess comorbidity resolution in earlier trials). Through a deeper investigation into the metabolic changes occurring independently of weight loss, this research aims to gain a clearer understanding of the underlying mechanisms and ultimately provide Level I evidence that could influence global bariatric surgery guidelines.
The study was approved by the Ethics Committee of Zurich with BASEC-Nr. 2019-02392.
The study is registered on ClinicalTrials.gov with ID NCT04219787 (ClinicalTrials.gov).
Collaborations
Part 3 of the SLIM project (Swiss Multicenter Randomized Controlled Trial on Different Limb Lengths in Gastric Bypass Surgery - Part 3: Metabolic Mechanisms and Inflammatory Response), initiated by Prof. Ralph Peterli in 2022, investigates the metabolic effects of bariatric surgery by focusing on the underlying biological mechanisms driving improving outcomes. This part of the project specifically examines the impact of different limb lengths in laparoscopic proximal Roux-en-Y gastric bypass (LRYGB) on metabolic and inflammatory pathways.
By comparing standard LRYGB with an extended biliopancreatic limb (BPL) configuration, the study examines changes in gut microbiota, intestinal enteroendocrine cell populations, glycemic control, macrophage subtypes, metabolite profiles across various biological samples (blood, urine, stool, and breath), and gene expression patterns, as well as epigenetic modifications (such as DNA-methylation) before and after bariatric surgery in tissue samples from the ileum and transverse colon. This study also evaluated body composition changes using bioimpedance analysis (BIA).
The study was approved by the Ethics Committee of Zurich with BASEC-Nr. 2019-02392. The study is registered on ClinicalTrials.gov with ID NCT05471037 (ClinicalTrials.gov).
The partnership between Prof. Bueter and Prof. Peterli bridges expertise in metabolic and bariatric research, ensuring a comprenhensive analysis of the physiological and biochemical effects of altered limb length in gastric bypass surgery. By contribuiting to this effort, our team is helping to unravel the complex metabolic interactions that influence surgical outcomes, with ultimate goal of refining bariatric procedures for enhanced patient benefits.
Scientific Publications
(2021)
Kraljević, M., Schneider, R., Wölnerhanssen, B., Bueter, M., Delko, T., Peterli, R., 2021.
Trials 22, 352 (2021).