Artificial Intelligence-Based Comparison of Duodenojejunostomy and Sleeve Gastrectomy on Pancreatic Morphology in Zucker Diabetic Fatty Rats

Introduction Obesity and type 2 diabetes mellitus (T2D) are interrelated metabolic disorders with increasing global incidence. Bariatric surgeries such as sleeve gastrectomy (SG) and Roux-en Y gastric bypass (RYGB) improve glycemic control, yet their effects on pancreatic morphology and function remain incompletely understood. This study compared the effects of SG, duodenojejunostomy (DJOS), and their combination (DJOS + SG) on glucose regulation and pancreatic histomorphology in Zucker diabetic fatty (ZDF) rats using artificial intelligence (AI)-assisted tissue analysis. Methods 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 beta cell mass, PCNA and PDX-1 expression. QuPath software enabled AI-based quantification of acinar, adipose, and fibrotic tissue. Results DJOS and DJOS + SG improved glucose tolerance and increased fasting insulin compared to SG. Both bypass groups demonstrated greater beta cell mass and clustering, elevated 6 PCNA and PDX-1 expression, and more acinar tissue. SG was associated with reduced beta cell presence and increased pancreatic adiposity. Conclusions Malabsorptive (DJOS) or combination bariatric procedures (DJOS + SG) significantly enhance glycemic control in the rat model. Concomitantly, beta cell apoptosis is reduced, leading to increased beta cell numbers and clustering, along with enhanced beta cell proliferation and differentiation. Acinar glandular tissue is increased with a reduction in pancreatic adiposity following bypass surgery.