ナベクラ　タイキ   Nabekura Taiki   鍋倉　大樹    所属   東邦大学  医学部 医学科（佐倉病院）    職種   助教
論文種別	症例報告
言語種別	英語
査読の有無	査読あり
表題	Proximal Jejunal Bypass with Sleeve Gastrectomy for Severe Obesity and Type 2 Diabetes: First Case Report in Japan
掲載誌名	正式名：Surgical case reports 略　 称：Surg Case Rep ISSNコード：21987793
掲載区分	国内
巻・号・頁	11(1)
著者・共著者	Taiki Nabekura, Takashi Oshiro, Kotaro Wakamatsu
担当区分	筆頭著者
発行年月	2025/10/17
概要	INTRODUCTION: Laparoscopic sleeve gastrectomy is the most common metabolic bariatric surgery performed in Japan. Nevertheless, concerns persist regarding its long-term efficacy, which is considered inferior to that of procedures involving gastrointestinal bypass. In response to these concerns, a modified approach known as the “sleeve plus procedure” has been introduced and is now covered by insurance for patients with severe obesity and type 2 diabetes mellitus (T2DM). We successfully performed proximal jejunal bypass with sleeve gastrectomy (PJB-SG), a variant of this approach, marking the first documented case of its kind in Japan. This report presents the clinical outcomes of this procedure along with a review of the relevant literature. CASE PRESENTATION: A 50-year-old female patient with a body mass index of 46.9 kg/m2 presented with obstructive sleep apnea and T2DM. The patient exhibited resistance to pharmacological treatment, including glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter 2 (SGLT2) inhibitors. Fifteen months after the initial consultation, she opted for PJB-SG. The operation lasted 207 min, with 18 mL of blood loss. At 252 days postoperatively, the patient had achieved a total weight loss of 18.0% and a hemoglobin A1c level of 6.0% while continuing a minimal dose of SGLT2 inhibitors. No adverse events related to the bypass procedure, such as diarrhea or liver dysfunction, were observed. CONCLUSIONS: To our knowledge, this is the first reported case of PJB-SG conducted in Japan. This procedure may represent a promising alternative for patients with severe obesity and T2DM in Japan.