{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T08:49:47Z","timestamp":1780390187549,"version":"3.54.1"},"reference-count":52,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T00:00:00Z","timestamp":1779408000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Gastrojejunal\u2013ileal interposition with bipartition and sleeve gastrectomy (GJIB-SG) is a novel metabolic procedure developed to combine functional foregut exclusion with hindgut stimulation while preserving duodenal continuity and endoscopic biliary access. This study evaluated the medium-term glycemic, weight-loss, and nutritional safety outcomes of GJIB-SG in patients with obesity and long-standing type 2 diabetes (T2D). Methods: A retrospective single-center cohort of 30 consecutive patients with obesity and T2D who underwent GJIB-SG between January 2016 and August 2019 and reached at least 60 months of postoperative follow-up was analyzed at baseline and at 12, 24, 36, 48, and 60 months. Longitudinal data were analyzed by repeated-measures ANOVA with Greenhouse\u2013Geisser correction and Bonferroni-adjusted pairwise comparisons. Diabetes remission was classified using the 2021 American Diabetes Association consensus definition (A1C &lt; 6.5%, medication-free). Results: Mean body weight decreased from 102.4 \u00b1 13.6 kg preoperatively to 73.5 \u00b1 7.6 kg at 60 months (p &lt; 0.001; mean %TWL 27.4%, mean %EWL 99.4%). Mean A1C decreased from 9.4 \u00b1 1.6% to 6.0 \u00b1 1.4% at 60 months (p &lt; 0.001). Complete medication-free remission was achieved by 70.0% of patients at 12 months and 44.8% at 60 months; cumulatively, 25 of 30 (83.3%) achieved complete remission at one or more intervals, and 3 patients (10.0%) never achieved A1C &lt; 6.5%. Triglycerides, total cholesterol, and LDL cholesterol decreased by 56%, 39%, and 35%, respectively. No protein\u2013energy malnutrition or hypoalbuminemia occurred; however, a late rise in parathyroid hormone and a return of 25-OH vitamin D toward preoperative insufficient values by 60 months indicate the need for sustained micronutrient surveillance. One cardiovascular death at 24 months was not considered procedure related. Conclusions: In this single-center cohort, GJIB-SG was associated with durable weight loss, sustained glycemic improvement with cumulative complete remission in 83.3% of patients, and absence of severe nutritional complications over 60 months. Prospective comparative studies with longitudinal mixed-effects analysis are warranted to define the role of GJIB-SG within the metabolic\u2013surgical armamentarium.<\/jats:p>","DOI":"10.3390\/jcm15114027","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T13:12:08Z","timestamp":1779455528000},"page":"4027","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Outcomes of a Novel Surgery: Gastrojejunal\u2013Ileal Interposition with Bipartition and Sleeve Gastrectomy for Type 2 Diabetes and Obesity"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9842-8571","authenticated-orcid":false,"given":"Tugrul","family":"Demirel","sequence":"first","affiliation":[{"name":"Department of General Surgery, Faculty of Medicine, Trakya University, Edirne 22030, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Necdet","family":"Sut","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Medical Informatics, Faculty of Medicine, Trakya University, Edirne 22030, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Surendra","family":"Ugale","sequence":"additional","affiliation":[{"name":"Department of Advanced Laparoscopy & Bariatric-Metabolic Surgery, Kirloskar Hospital, Hyderabad 500004, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,22]]},"reference":[{"key":"ref_1","unstructured":"Federation, I.D. (2025). IDF Diabetes Atlas, IDF. [11th ed.]. Available online: https:\/\/diabetesatlas.org."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"American Diabetes Association Professional Practice Committee (2024). 1. Improving care and promoting health in populations: Standards of care in diabetes\u20142025. Diabetes Care, 48, S14\u2013S26.","DOI":"10.2337\/dc25-S001"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"860169","DOI":"10.1155\/2011\/860169","article-title":"Improvement of type 2 diabetes mellitus in obese and non-obese patients after the duodenal switch operation","volume":"2011","author":"Frenken","year":"2011","journal-title":"J. Obes."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1510","DOI":"10.2337\/dc15-2481","article-title":"Durability of addition of Roux-en-Y gastric bypass to lifestyle intervention and medical management in achieving primary treatment goals for uncontrolled type 2 diabetes in mild to moderate obesity: A randomized control trial","volume":"39","author":"Ikramuddin","year":"2016","journal-title":"Diabetes Care"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1097\/00000658-200211000-00003","article-title":"Potential of surgery for curing type 2 diabetes mellitus","volume":"236","author":"Rubino","year":"2002","journal-title":"Ann. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1592","DOI":"10.1007\/s11695-025-07825-5","article-title":"Gastro-jejunal ileal interposition with bipartition: A salvage procedure for severe protein-energy malnutrition after transit bipartition","volume":"35","author":"Demirel","year":"2025","journal-title":"Obes. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1186\/s40200-014-0089-y","article-title":"Prediction of remission after metabolic surgery using a novel scoring system in type 2 diabetes\u2014A retrospective cohort study","volume":"13","author":"Ugale","year":"2014","journal-title":"J. Diabetes Metab. Disord."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1313","DOI":"10.1007\/s00464-008-0156-x","article-title":"Laparoscopic ileal interposition associated to a diverted sleeve gastrectomy is an effective operation for the treatment of type 2 diabetes mellitus patients with BMI 21\u201329","volume":"23","author":"DePaula","year":"2009","journal-title":"Surg. Endosc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1007\/s00464-007-9472-9","article-title":"Laparoscopic treatment of type 2 diabetes mellitus for patients with a body mass index less than 35","volume":"22","author":"DePaula","year":"2008","journal-title":"Surg. Endosc."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Demirel, T., and Ugale, S. (2026, May 11). Intraoperative Video: Gastrojejunal-Ileal Interposition with Bipartition and Sleeve Gastrectomy (GJIB-SG)\u2014A Novel Metabolic Surgery for Type 2 Diabetes and Obesity. Available online: https:\/\/figshare.com\/articles\/media\/_b_Intraoperative_Video_Gastrojejunal-Ileal_Interposition_with_Bipartition_and_Sleeve_Gastrectomy_GJIB-SG_A_Novel_Metabolic_Surgery_for_Type_2_Diabetes_and_Obesity_b_\/32141269\/1?file=64150663.","DOI":"10.3390\/jcm15114027"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2296","DOI":"10.1007\/s11695-025-07858-w","article-title":"Effect of gastric bypass vs. sleeve gastrectomy on remission of type 2 diabetes mellitus among patients with severe obesity: A meta-analysis","volume":"35","author":"Queiroz","year":"2025","journal-title":"Obes. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.soard.2017.10.023","article-title":"Diabetes resolution after one anastomosis gastric bypass","volume":"14","author":"Lessing","year":"2018","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"3439","DOI":"10.1007\/s11695-018-3405-7","article-title":"Mgb-oagb: Effect of biliopancreatic limb length on nutritional deficiency, weight loss, and comorbidity resolution","volume":"28","author":"Ahuja","year":"2018","journal-title":"Obes. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"S7","DOI":"10.21037\/atm.2020.02.03","article-title":"Efficiency and risks of one-anastomosis gastric bypass","volume":"8","author":"Aleman","year":"2020","journal-title":"Ann. Transl. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1381\/096089201321454114","article-title":"Duodenal switch: An effective therapy for morbid obesity-Intermediate results","volume":"11","author":"Baltasar","year":"2001","journal-title":"Obes. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1392","DOI":"10.1016\/j.soard.2022.08.010","article-title":"Impact of biliopancreatic diversion with duodenal switch on glucose homeostasis and gut hormones and their correlations with appetite","volume":"18","author":"Elias","year":"2022","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"4555","DOI":"10.1007\/s11695-024-07564-z","article-title":"Efficacy of one anastomosis gastric bypass versus sleeve gastrectomy and Roux-en-Y gastric bypass for the treatment of type 2 diabetes mellitus: A systematic review and meta-analysis of randomized clinical trials","volume":"34","author":"Kermansaravi","year":"2024","journal-title":"Obes. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.1007\/s11695-008-9435-9","article-title":"Duodenal switch: Long-term results","volume":"17","author":"Marceau","year":"2007","journal-title":"Obes. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/S0140-6736(20)32649-0","article-title":"Metabolic surgery versus conventional medical therapy in patients with type 2 diabetes: 10-year follow-up of an open-label, single-centre, randomised controlled trial","volume":"397","author":"Mingrone","year":"2021","journal-title":"Lancet"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1381\/096089206777346637","article-title":"Biliopancreatic diversion: Mechanisms of action and long-term results","volume":"16","author":"Scopinaro","year":"2006","journal-title":"Obes. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1016\/S2213-8587(24)00396-6","article-title":"Effect of gastric bypass versus sleeve gastrectomy on the remission of type 2 diabetes, weight loss, and cardiovascular risk factors at 5 years (Oseberg): Secondary outcomes of a single-centre, triple-blind, randomised controlled trial","volume":"13","author":"Borgeraas","year":"2025","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_22","first-page":"1051","article-title":"Comparison of 1-year outcomes between Roux-en-Y gastric bypass and sleeve gastrectomy with Roux-en-Y duodenojejunal bypass in the patients of obesity with type 2 diabetes mellitus","volume":"26","author":"Liang","year":"2023","journal-title":"Zhonghua Wei Chang. Wai Ke Za Zhi"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1159\/000526718","article-title":"Weight loss, type 2 diabetes, and nutrition in 355 patients with obesity undergoing sleeve gastrectomy with transit bipartition: Two-year outcomes","volume":"15","author":"Al","year":"2022","journal-title":"Obes. Facts"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2631","DOI":"10.1007\/s00464-021-08769-4","article-title":"Sleeve gastrectomy with transit bipartition in a series of 883 patients with mild obesity: Early effectiveness and safety outcomes","volume":"36","author":"Al","year":"2022","journal-title":"Surg. Endosc."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1097\/SLE.0000000000000541","article-title":"Early results of laparoscopic sleeve gastrectomy with loop bipartition","volume":"28","author":"Arslan","year":"2018","journal-title":"Surg. Laparosc. Endosc. Percutan Tech."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"3012","DOI":"10.1007\/s11695-018-3239-3","article-title":"A prospective randomized controlled trial of the metabolic effects of sleeve gastrectomy with transit bipartition","volume":"28","author":"Azevedo","year":"2018","journal-title":"Obes. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1007\/s11695-018-3603-3","article-title":"Metabolic effects of sleeve gastrectomy with transit bipartition in obese females with type 2 diabetes mellitus: Results after 1-year follow-up","volume":"29","author":"Bilecik","year":"2019","journal-title":"Obes. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"4724","DOI":"10.1007\/s11695-021-05536-1","article-title":"The mid-term effects of transit bipartition with sleeve gastrectomy on glycemic control, weight loss, and nutritional status in patients with type 2 diabetes mellitus: A retrospective analysis of a 3-year follow-up","volume":"31","author":"Calisir","year":"2021","journal-title":"Obes. Surg."},{"key":"ref_29","first-page":"199","article-title":"Comparative evaluation of efficiency for gastroileostomy anastomosis in laparoscopic transit bipartition with sleeve gastrectomy between linear and circular staplers","volume":"17","author":"Gulaydin","year":"2022","journal-title":"Wideochir Inne Tech. Maloinwazyjne"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1007\/s11695-019-04326-0","article-title":"Effects of sleeve gastrectomy with transit bipartition on glycemic variables, lipid profile, liver enzymes, and nutritional status in type 2 diabetes mellitus patients","volume":"30","author":"Karaca","year":"2020","journal-title":"Obes. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1097\/SLA.0b013e31825370c0","article-title":"Sleeve gastrectomy with transit bipartition: A potent intervention for metabolic syndrome and obesity","volume":"256","author":"Santoro","year":"2012","journal-title":"Ann. Surg."},{"key":"ref_32","first-page":"110","article-title":"Neuroendocrine brake for the treatment of morbid obesity: Preliminary report","volume":"3","author":"Macedo","year":"2005","journal-title":"Einstein"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1016\/j.soard.2006.03.005","article-title":"Laparoscopic sleeve gastrectomy with ileal interposition (\u201cneuroendocrine brake\u201d)\u2014pilot study of a new operation","volume":"2","author":"Macedo","year":"2006","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1016\/j.soard.2009.10.005","article-title":"Prospective randomized controlled trial comparing 2 versions of laparoscopic ileal interposition associated with sleeve gastrectomy for patients with type 2 diabetes with BMI 21\u201334 kg\/m2","volume":"6","author":"Stival","year":"2010","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1724","DOI":"10.1007\/s00464-008-0168-6","article-title":"Hormonal evaluation following laparoscopic treatment of type 2 diabetes mellitus patients with BMI 20\u201334","volume":"23","author":"DePaula","year":"2009","journal-title":"Surg. Endosc."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"589","DOI":"10.4103\/2230-8210.98017","article-title":"Ileal interposition with sleeve gastrectomy for treatment of type 2 diabetes mellitus","volume":"16","author":"Kota","year":"2012","journal-title":"Indian J. Endocrinol. Metab."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1007\/s00464-020-07430-w","article-title":"Single anastomosis sleeve ileal (SASI) bypass versus sleeve gastrectomy: A case-matched multicenter study","volume":"35","author":"Emile","year":"2021","journal-title":"Surg. Endosc."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2744","DOI":"10.1007\/s00268-022-06706-7","article-title":"The effect of single-anastomosis sleeve ileal (SASI) bypass on patients with severe obesity in three consecutive years","volume":"46","author":"Hosseini","year":"2022","journal-title":"World J. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"4286","DOI":"10.1007\/s11695-020-04781-0","article-title":"1-year follow-up of single anastomosis sleeve ileal (SASI) bypass in morbid obese patients: Efficacy and concerns","volume":"30","author":"Kermansaravi","year":"2020","journal-title":"Obes. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1007\/s11695-020-04945-y","article-title":"Single-anastomosis sleeve ileal (SASI) bypass: Hopes and concerns after a two-year follow-up","volume":"31","author":"Khalaf","year":"2021","journal-title":"Obes. Surg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.ijsu.2016.08.018","article-title":"Efficacy of single anastomosis sleeve ileal (SASI) bypass for type-2 diabetic morbid obese patients: Gastric bipartition, a novel metabolic surgery procedure: A retrospective cohort study","volume":"34","author":"Mahdy","year":"2016","journal-title":"Int. J. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1007\/s11695-019-04296-3","article-title":"Evaluation of the efficacy of single anastomosis sleeve ileal (SASI) bypass for patients with morbid obesity: A multicenter study","volume":"30","author":"Mahdy","year":"2020","journal-title":"Obes. Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1080\/08941939.2016.1241841","article-title":"Single anastomosis sleeve ileal bypass: New step in the evolution of bariatric surgeries","volume":"30","author":"Salama","year":"2017","journal-title":"J. Investig. Surg."},{"key":"ref_44","first-page":"365","article-title":"Single anastomosis sleeve ileal bypass (SASI): A single-center initial report","volume":"17","author":"Tarnowski","year":"2022","journal-title":"Wideochir Inne Tech. Maloinwazyjne"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.ijscr.2013.12.002","article-title":"Laparoscopic sleeve gastrectomy with loop bipartition: A novel metabolic operation in treating obese type II diabetes mellitus","volume":"5","author":"Mui","year":"2014","journal-title":"Int. J. Surg. Case Rep."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1007\/s11695-023-06988-3","article-title":"One anastomosis transit bipartition (OATB): Rational and mid-term outcomes","volume":"34","author":"Ribeiro","year":"2023","journal-title":"Obes. Surg."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.soard.2007.02.003","article-title":"Role of the bypassed proximal intestine in the anti-diabetic effects of bariatric surgery","volume":"3","author":"Cummings","year":"2007","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1097\/01.sla.0000224726.61448.1b","article-title":"The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes","volume":"244","author":"Rubino","year":"2006","journal-title":"Ann. Surg."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1007\/s11695-020-04890-w","article-title":"Excessive weight loss and hypoalbuminemia after sasi bypass: The need for standardization of the technique","volume":"31","author":"Emile","year":"2021","journal-title":"Obes. Surg."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"e102","DOI":"10.1097\/AS9.0000000000000102","article-title":"Short-term results of transit bipartition to promote weight loss after laparoscopic sleeve gastrectomy","volume":"2","author":"Reiser","year":"2021","journal-title":"Ann. Surg. Open"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/j.soard.2019.12.019","article-title":"Is transit bipartition a better alternative to biliopancreatic diversion with duodenal switch for superobesity? Comparison of the early results of both procedures","volume":"16","author":"Topart","year":"2020","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"3402","DOI":"10.1007\/s11695-020-04691-1","article-title":"Comparison of 2-year results of Roux-en-Y gastric bypass and transit bipartition with sleeve gastrectomy for superobesity","volume":"30","author":"Topart","year":"2020","journal-title":"Obes. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/11\/4027\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T04:17:30Z","timestamp":1779941850000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/11\/4027"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,22]]},"references-count":52,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jcm15114027"],"URL":"https:\/\/doi.org\/10.3390\/jcm15114027","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,22]]}}}