Guide to Duodenal Switch (BPD-DS)

Reviewed by weight loss surgeon Francisco Guzman, MD, January 2025

Duodenal Switch is a weight loss surgery that dramatically alters the anatomy of the digestive tract to induce significant weight loss.

Key Facts

Duodenal Switch

The surgery combines elements of two common weight loss surgeries: a sleeve gastrectomy and gastric bypass.
In some extremely overweight patients, this operation can be performed in two stages over a period of a few months.
Duodenal switch results in the greatest, most reliable, and longest lasting weight loss of all weight loss procedures.

What is a Duodenal Switch?

A duodenal switch (also called a bilio-pancreatic diversion with duodenal switch, or BPD-DS) is a complex weight loss surgery procedure that induces weight loss using a sleeve gastrectomy and an intestinal bypass.

Why is it called a Duodenal Switch?

The name duodenal switch comes from the fact that in this operation the intestinal bypass starts at the duodenum. The first part of the intestine, the duodenum, is divided and attached to the lower portion of the small intestine, the ileum.

Why Have a Duodenal Switch?

Duodenal switch surgery can help you lose excess weight and reduce your risk of other life-threatening health problems. It is usually an option for obese patients that have struggled to lose weight using diet and exercise. Duodenal switch induces greater and longer lasting weight loss compared to any other weight loss surgery.

By losing excess weight, other illnesses associated with obesity can greatly improve. Results have shown a significant reduction in conditions like diabetes and sleep apnea.

How weight loss can affect you directly to improve your health should be discussed with your physician.

Duodenal switch surgery may also be used as a revision operation for gastric sleeve patients who have not lost enough weight or who regain significant weight.

Am I a Candidate for Duodenal Switch Surgery?

The duodenal switch procedure is typically an option only for patients who are significantly overweight and have had trouble losing weight using diet and exercise.

The typical criteria for duodenal switch surgery include:

A body mass index (BMI) that is greater than 50
Significant weight-related medical conditions

How is a Duodenal Switch Performed?

The duodenal switch procedure has two phases: A sleeve gastrectomy and an intestinal bypass.

For the sleeve portion, the surgeon removes approximately 60-70 percent of the stomach so that the stomach takes the shape of a tube.

For the intestinal bypass portion of the operation, the lower intestine is divided so that two thirds or more of the intestine is bypassed. This leaves only a few feet of intestine where food and digestive enzymes meet.

How Does the Procedure Cause Weight Loss?

When the smaller stomach fills with food, a feeling of fullness or satiety occurs. Patients simply can't eat as much as they did before surgery because this small sleeve can only accommodate a few ounces of food at a time.

Shrinking the stomach also reduces the body's level of ghrelin, commonly referred to as the "hunger hormone." Many people find that they are much less hungry after the procedure.

Ghrelin also plays a role in blood sugar metabolism. People with type II diabetes often see an immediate decrease in their need for diabetes medications (especially oral medications) after the procedure.

The reconnected intestine also causes the food to bypass part of the intestine so some of the nutrients and calories in food will not be absorbed. Patients subsequently lose weight.

The duodenal switch bypasses a much larger portion of the intestine than a gastric bypass, and has a greater effect on digestion.

Stories & Perspectives

In Their Own Words: Patients Describe Their Transformations

What Options Do I Have for My Procedure?

In some extremely overweight patients this operation is performed in 2 stages: the sleeve gastrectomy is performed first, followed 9-12 months later by the intestinal bypass portion of the procedure.

What Kind of Anesthesia is Used for a Duodenal Switch?

A duodenal switch is performed under general anesthesia, so you will not be awake during the procedure.

How Do I Prepare for My Duodenal Switch Surgery?

Your surgeon will give you specific instructions to help make your procedure more successful. These include adhering to a special diet and discontinuing smoking and certain medications prior to your surgery.

What are the Risks of a Duodenal Switch?

Like any surgery, a duodenal switch carries some risk for complications; the risk for these complications are increased for obese patients. Some potential risks that are specific to the procedure include:

Gastroesophageal Reflux (GERD) – Because the procedure reduces the size of the stomach, it may also increase pressure on the esophagus. This pressure can cause reflux.
Dumping Syndrome – Food moving quickly from the stomach into the small intestine can cause uncomfortable symptoms, including nausea, vomiting, diarrhea, cramping, and fatigue.
Stomach Leakage – The seam where the stomach has been stapled back together may leak.
Food restrictions – Overly fatty and greasy foods may not be tolerated well.
Complications at Reconnection Site – Long term complications related to the intestinal reconnection can also occur.
Changes to Bowel Movements – Since this operation induces a state of decreased absorption, patients will likely experience more frequent and looser bowel movements and increased flatulence.
Long-term Nutrient Deficiencies – Changes in how your body digests food can lead to long-term deficiencies of vitamin B12, folate, iron and other vitamins and minerals if dietary supplement recommendations are not followed.

It's also important to remember that a duodenal switch is non-reversible and may not provide the desired weight loss results.

A detailed discussion of the risks of surgery should be a part of your pre-operative discussion with your surgeon.

What is Recovery Like After a Duodenal Switch?

For the first few weeks after surgery, you will need to follow a carefully monitored diet, starting with a liquid diet and slowly reintroducing specific types of food. Most patients find that after a reasonable recovery, they are able to comfortably eat a wide variety of foods, including meats and fibrous vegetables.

It is important that patients who have had a duodenal switch procedure make a lifelong commitment to making the necessary changes in their diet. This includes maintaining an adequate intake of protein, taking vitamin and mineral supplements including a multivitamin, B12, iron and calcium, and avoiding sweets and fatty foods.

How Much Weight Can I Expect to Lose?

Most patients can expect to lose 70 to 80 percent of their excess body weight over a 2-year period.

How Long Will the Benefits of a Duodenal Switch Surgery Last?

How well you comply with diet recommendations and exercise will greatly contribute to your final weight. Clinical trials have demonstrated that patients can maintain weight loss of about 70% of excess body weight for 10 years or longer.

Next Steps

If you’d like to learn more about having duodenal switch surgery or other weight-loss procedures, our team at Columbia is here to help. Call us at (212) 305-4000 or request an appointment online. We accept a number of insurance plans, and our team can help confirm your coverage.