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Background <p>Metabolic surgery has shown effectiveness in the management of some patients with type 2 diabetes (T2D). However, the evidence for metabolic surgery in type 1 diabetes (T1D) remains scarce. This pilot study aimed to evaluate the feasibility, safety, and metabolic impact of partial duodeno-ileal diversion (PDID) using a novel magnetic compression small bowel anastomosis (MCA) system in a T1D porcine model.</p> Methods <p>Ten adult Yorkshire pigs were subjected to intravenous infusion of streptozotocin (STZ) to induce T1D. Diabetic pigs were randomized to either PDID via MCA or control with no operation. The proximal magnet was placed in the duodenum, and the distal magnet was inserted into the distal ileum about 40&#xa0;cm proximal to the ileocecal valve through a small enterotomy, and magnetic coupling ensued. Procedural feasibility (MCA device coupling efficiency, anastomotic patency) and safety (e.g. burst pressure, device-related complications, survival) were evaluated. Postoperative changes including fasting plasma glucose (FPG), body weight, Homeostatic Model Assessment of Insulin Resistance [HOMA-IR]) were assessed periodically up to 6 weeks postoperatively. Histopathologic and immunohistochemical changes in the distal ileum and pancreas were also evaluated.</p> Results <p>Five adult Yorkshire pigs underwent successful PDID via MCA, and 5 unoperated counterparts served as controls. One pig in each group died soon after induction, likely due to STZ toxicity. Anastomotic magnets were expelled per rectally within 14 days of PDID without any complications. In postoperative week 3, FPG normalized to a mean of 5.13 (±0.618) mmol/L in the PDID group and remained stable, whereas in the control group, mean FPG levels were persistently elevated at a mean of 30.28 (±3.168, <i>p</i> &lt; 0.001) mmol/L. The PDID group had a mean HOMA-IR value of 0.892 (±0.220), in contrast to the control group’s mean of 6.056 (±0.803, <i>p</i> &lt; 0.001). Histopathological examinations showed satisfactory tissue healing at the anastomotic sites of all pigs in the PDID group, focal hyperplasia of beta cells in the pancreas of all pigs that underwent PDID, and increased immunostaining for synaptophysin, glucagon-like peptide-1 and proinsulin in the distal ileum and pancreatic tissues in the PDID group, as compared with the controls.</p> Conclusions <p>PDID via MCA is safe and effective in optimization of glycemic control in this STZ-induced T1D porcine model. Further preclinical validation and evaluation of metabolic changes in response to this novel intervention in different large animal models of T1D is needed before clinical trials in humans.</p>

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Partial Duodeno-Ileal Diversion with Magnetic Compression Anastomosis: A Novel Approach for the Treatment of Type 1 Diabetes-Associated Metabolic Derangements in a Porcine Model

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月5日

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  • Chung Kwong Yeung,
  • Lung Yi Mak,
  • Yuzhang Wang,
  • Biji Sreedhar,
  • Fraser Ian Hill,
  • Hequn Zou,
  • Ho Wai Howard Chan,
  • Hao Sun,
  • Kwong Hung Keith Lau,
  • Erik Fung

摘要

Background

Metabolic surgery has shown effectiveness in the management of some patients with type 2 diabetes (T2D). However, the evidence for metabolic surgery in type 1 diabetes (T1D) remains scarce. This pilot study aimed to evaluate the feasibility, safety, and metabolic impact of partial duodeno-ileal diversion (PDID) using a novel magnetic compression small bowel anastomosis (MCA) system in a T1D porcine model.

Methods

Ten adult Yorkshire pigs were subjected to intravenous infusion of streptozotocin (STZ) to induce T1D. Diabetic pigs were randomized to either PDID via MCA or control with no operation. The proximal magnet was placed in the duodenum, and the distal magnet was inserted into the distal ileum about 40 cm proximal to the ileocecal valve through a small enterotomy, and magnetic coupling ensued. Procedural feasibility (MCA device coupling efficiency, anastomotic patency) and safety (e.g. burst pressure, device-related complications, survival) were evaluated. Postoperative changes including fasting plasma glucose (FPG), body weight, Homeostatic Model Assessment of Insulin Resistance [HOMA-IR]) were assessed periodically up to 6 weeks postoperatively. Histopathologic and immunohistochemical changes in the distal ileum and pancreas were also evaluated.

Results

Five adult Yorkshire pigs underwent successful PDID via MCA, and 5 unoperated counterparts served as controls. One pig in each group died soon after induction, likely due to STZ toxicity. Anastomotic magnets were expelled per rectally within 14 days of PDID without any complications. In postoperative week 3, FPG normalized to a mean of 5.13 (±0.618) mmol/L in the PDID group and remained stable, whereas in the control group, mean FPG levels were persistently elevated at a mean of 30.28 (±3.168, p < 0.001) mmol/L. The PDID group had a mean HOMA-IR value of 0.892 (±0.220), in contrast to the control group’s mean of 6.056 (±0.803, p < 0.001). Histopathological examinations showed satisfactory tissue healing at the anastomotic sites of all pigs in the PDID group, focal hyperplasia of beta cells in the pancreas of all pigs that underwent PDID, and increased immunostaining for synaptophysin, glucagon-like peptide-1 and proinsulin in the distal ileum and pancreatic tissues in the PDID group, as compared with the controls.

Conclusions

PDID via MCA is safe and effective in optimization of glycemic control in this STZ-induced T1D porcine model. Further preclinical validation and evaluation of metabolic changes in response to this novel intervention in different large animal models of T1D is needed before clinical trials in humans.