I read with great enthusiasm the article published in your esteemed journal titled, “Diabetes remission after LRYGB with and without fundus resection: a randomized clinical trial” by Kehagias et al. [1]

The premise of the article is quite interesting and it seeks to understand the role of fundus resection in diabetes remission. I have a few issues regarding this article that I would like to bring to your attention.

I would also highlight that diabetes remission is already “significant” without fundus resection. Hence, adding a step that increases remission rates marginally may not necessarily be appropriate.

Next, The study conducts an extensive biochemical analysis of multiple hormones in patients undergoing the procedure, but if it translates into clinical practice remains a matter of question. The study also conveniently excludes patients with duration of diabetes longer than 8 years, but this is a fallacy. As duration of comorbidity is in itself a selection criteria for type of bariatric procedure with patients having longer comorbidity duration are preferred for a mal-absorptive procedure such as Roux-en-Y gastric bypass.

The study reports significantly more weight loss in the group with fundus resection as compared to the group without. This observed difference is significant and seems to provide an area for more research.

Also, the study does not clearly mention how diabetes resolution was seen in patients on follow up. No evidence of fasting glucose, post prandial glucose and random glucose readings have been reported in this study.

I would definitely highlight the small sample size of the study. This is an imperative factor and stands in the way of performing a detailed analysis. Unless this study is expanded to a larger study population at multiple centers, with multiple participating doctors, hospitals, in multiple ethnic groups, it would be difficult for us to draw any significant conclusions.

In the end, I would like to commend the authors for performing a well conducted clinical trial.