Dear Sir,

We read with interest the article by Habegger et al1 who demonstrated that duodenal nutrient exclusion using duodenal endoluminal sleeve (DES) improves metabolic syndrome and stimulates intestinal villus hyperplasia, especially the bypassed duodenum, in a rodent model of type 2 diabetes mellitus. There were three intriguing results. First, with regard to DES improving glucose homeostasis, the area under curve analysis showed that both sham-operated and the DES group had statistically significant improvements in glucose homeostasis. Nevertheless, since the pair-fed group had received the same sham operation, it is interesting that the sham-operated group rather than the pair-fed group showed …