# Artificial intelligence-based comparison of the effects of duodenojejunostomy and sleeve gastrectomy on pancreatic morphology in Zucker diabetic fatty rats

## TL;DR

This study compares how different bariatric surgeries affect blood sugar and pancreatic health in diabetic rats using AI analysis.

## Contribution

The novel use of AI-assisted tissue analysis to compare the effects of bariatric surgeries on pancreatic morphology in diabetic rats.

## Key findings

- DJOS and DJOS + SG improved glucose tolerance and increased fasting insulin compared to SG.
- Bypass surgeries increased β-cell mass, clustering, PCNA, and PDX-1 expression while reducing pancreatic adiposity.
- SG was associated with reduced β-cell presence and increased pancreatic adiposity.

## Abstract

This study aims to compare the effects of sleeve gastrectomy (SG), duodenojejunostomy (DJOS), and their combination (DJOS + SG) on glucose regulation and pancreatic histomorphology and function in Zucker diabetic fatty (ZDF) rats, using artificial intelligence (AI)–assisted tissue analysis to assess morphological alterations.

Forty-five male ZDF rats were randomized into three surgical groups (SG, DJOS, DJOS + SG). Oral glucose tolerance tests (OGTT) and insulin levels were assessed at 1, 3 and 6 months post-surgery. Pancreatic tissue was analyzed histologically and immunohistochemically for β-cell mass, PCNA and PDX-1 expression. QuPath software enabled AI-based quantification of acinar, adipose, and fibrotic tissue.

DJOS and DJOS + SG improved glucose tolerance and increased fasting insulin compared to SG. Both bypass groups demonstrated greater β-cell mass and clustering, elevated PCNA and PDX-1 expression, and more acinar tissue. SG was associated with reduced β-cell presence and increased pancreatic adiposity.

Malabsorptive (DJOS) or combination bariatric procedures (DJOS + SG) significantly enhance glycemic control in the rat model. These effects are accompanied by increased β-cell numbers and clustering, as well as enhanced β-cell proliferation and differentiation. Furthermore, acinar glandular tissue is increased, while pancreatic adiposity is reduced following bypass surgery.