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

Marta Guimarães, Ana Marta Pereira, Sofia S Pereira, Rui Almeida, Carolina B Lobato, Bolette Hartmann, Jens J Holst, Mário Nora, Mariana P Monteiro


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.

Original languageEnglish
JournalObesity Research & Clinical Practice
Issue number2
Pages (from-to)166-170
Number of pages5
Publication statusPublished - 1 Mar 2023


  • Bariatrics
  • Biliopancreatic Diversion/methods
  • Blood Glucose
  • Blood Glucose Self-Monitoring
  • Duodenum/surgery
  • Female
  • Gastrectomy/methods
  • Gastric Bypass/methods
  • Glucagon
  • Glucose
  • Humans
  • Obesity, Morbid/surgery
  • Prospective Studies
  • Retrospective Studies
  • Twins, Monozygotic
  • Weight Loss/physiology


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