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In this procedure, 75%80% of the stomach is laparoscopically removed, forming a sleeve-like organ that limits food consumption and satiety-inducing changes in gut hormones ( 2.2 Roux-en-Y gastric bypass (RYGB) Roux-en-Y Gastric Bypass (RYGB) is an established bariatric procedure that delivers weight loss and improves metabolic health, particularly for patients with obesity and its comorbidities, such as type 2 diabetes ( 2.3 One anastomosis gastric bypass (OAGB) One Anastomosis Gastric Bypass (OAGB) is a bariatric surgery that promotes weight loss and improves metabolic health, serving as a simpler alternative to the traditional RYGB ( 2.4 Single anastomosis duodeno-ileostomy with sleeve gastrectomy (SADI-S) Single Anastomosis Duodeno-ileostomy with Sleeve Gastrectomy (SADI-S) is a bariatric surgery that effectively combines restrictive and malabsorptive techniques to promote significant weight loss and metabolic improvement

This is due to increased small intestinal sodium/glucose cotransporter 1 (SGLT1) expression and subsequent GLP-1 release following intestinal glucose infusion, which are mediated by metformin-induced alterations in the small intestinal microbiota 131

This significant reduction in liver fat content with cotadutide is likely to be due to hepatic glucagon signalling and subsequent upregulation of fatty acid oxidation