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Obesity Surgery Sep 2019
Topics: Dumping Syndrome; Gastrectomy; Gastric Bypass; Humans; Laparoscopy; Obesity, Morbid; Prevalence
PubMed: 31227985
DOI: 10.1007/s11695-019-04033-w -
United European Gastroenterology Journal Oct 2019Data on the efficacy and safety of the long-acting somatostatin analogue lanreotide (LAN) for postoperative dumping syndrome are lacking. (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND
Data on the efficacy and safety of the long-acting somatostatin analogue lanreotide (LAN) for postoperative dumping syndrome are lacking.
OBJECTIVE
We performed a double-blind, randomised and placebo-controlled crossover study of LAN Autogel® 90 mg in postoperative dumping.
METHODS
Adults with a positive prolonged oral glucose tolerance test or spontaneous hypoglycaemia and total dumping score (DS) ≥ 10 despite dietary measures were treated with three monthly injections of LAN or placebo in a randomised crossover fashion with an eight-week wash-out period. Primary outcome was the effect of LAN on total DS versus placebo. Secondary outcomes were the effect on early and late DS, treatment assessment, quality of life and safety.
RESULTS
Of 24 included patients (66.7% female; age 49.1 ± 2.1 years), 12 were randomised to LAN first. Pooled DS after three injections were lower compared to baseline after LAN (median=14 (interquartile range (IQR) 11.5-23) vs. median = 22 (IQR 16-27); = 0.03) but not placebo (median = 20 (IQR 15-27) vs. median = 23 (IQR 13-29); = 0.15). Improvement of early (median = 7.5 (IQR 4.5-13) vs. median = 12 (IQR 9-16); = 0.03) but not late (median = 7 (IQR 6-10.3) vs. median = 9 (IQR 6-13); = 0.26) DS was seen. Overall treatment assessment correlated with change in DS ( = -0.69, = 0.004). Symptom improvement was not associated with changes in quality of life. Of the 81 reported adverse events, 44 occurred on LAN compared to 37 on placebo ( > 0.05), with seven serious adverse events on LAN.
CONCLUSIONS
LAN is effective for treating early postoperative dumping symptoms, although side effects are common and quality of life is not significantly affected.
Topics: Adult; Antineoplastic Agents; Cross-Over Studies; Double-Blind Method; Dumping Syndrome; Female; Glucose Tolerance Test; Humans; Hypoglycemia; Male; Middle Aged; Peptides, Cyclic; Placebos; Postoperative Period; Quality of Life; Safety; Somatostatin; Treatment Outcome
PubMed: 31662863
DOI: 10.1177/2050640619862166 -
Surgical Endoscopy Nov 2023Post-prandial hypoglycemia is an uncommon but disabling late complication of Roux-en-Y gastric bypass (RYGB). Most patients can be treated with dietary interventions and...
BACKGROUND
Post-prandial hypoglycemia is an uncommon but disabling late complication of Roux-en-Y gastric bypass (RYGB). Most patients can be treated with dietary interventions and medications; however, some patients develop refractory hypoglycemia that may lead to multiple daily episodes and seizures. While RYGB reversal surgery is an effective treatment, complication rates are high, and patients inevitably experience weight regain. Transoral gastric outlet reduction (TORe) is a minimally invasive treatment that is effective for early and late dumping syndrome. However, prior studies have not distinguished the effectiveness of TORe specifically for patients with post-prandial hypoglycemia. This study aims to describe a single institution's experience of TORe for treating post-prandial hypoglycemia.
METHODS
This is a case series of patients with prior RYGB complicated by post-prandial hypoglycemia who underwent TORe from February 2020 to September 2021. Pre-procedural characteristics and post-procedural outcomes were obtained. Outcomes assessed included post-prandial hypoglycemia episodes, dumping syndrome symptoms, and weight change.
RESULTS
A total of 11 patients underwent TORe from 2020 to 2021 for post-prandial hypoglycemia. Three (27%) patients had a history of seizures due to hypoglycemia. All had been advised on dietary changes, and ten patients (91%) were on medications for dumping. All patients reported a reduction in post-prandial hypoglycemic events as well as the majority of dumping syndrome symptoms during an average follow-up time of 409 ± 125 days. Ten patients (91%) had experienced weight regain from their post-RYGB nadir weight. For these patients, the average total body weight loss 12 months post-TORe was 12.4 ± 12%. There were no complications requiring hospitalization. One patient experienced post-TORe nausea and vomiting requiring dilation of the gastrojejunal anastomosis with resolution in symptoms.
CONCLUSION
TORe is a safe and effective treatment for post-prandial hypoglycemia and weight regain after RYGB in patients with symptoms refractory to medications and dietary changes.
Topics: Humans; Gastric Bypass; Dumping Syndrome; Treatment Outcome; Hypoglycemia; Reoperation; Seizures; Weight Gain; Obesity, Morbid; Retrospective Studies
PubMed: 37674055
DOI: 10.1007/s00464-023-10389-z -
Neuro Endocrinology Letters Sep 2020Dumping syndrome is a common post-operative complication following gastric surgery. Clinically, severe dumping can be a serious medical condition with a negative impact...
Dumping syndrome is a common post-operative complication following gastric surgery. Clinically, severe dumping can be a serious medical condition with a negative impact on the patient's life. In our case report, we present a case of refractory dumping syndrome which developed after laparoscopic subtotal gastrectomy with gastrojejunoanastomosis due to massive gastroptosis with stomach evacuation problems. Conservative gastroenterology treatment was not successful. Due to the progression of weight loss and life-threatening hypoglycaemia, the decision for surgical treatment was made. After the corrective gastro-duodenal and jejuno-jejunal anastomoses, all clinical symptoms resolved completely. With regard to the presented case, we discuss the common treatment options for dumping syndrome: the standard recommendations for dietary habits, pharmacological treatment and finally the surgery and its pitfalls. Due to the absence of randomized trials and guidelines, every patient should be treated in a personalized way.
Topics: Adult; Anastomosis, Roux-en-Y; Dumping Syndrome; Female; Gastrectomy; Humans; Intestine, Small; Postoperative Complications; Stomach
PubMed: 33185991
DOI: No ID Found -
Digestive Surgery 2017Survival rates after a total gastrectomy with adequate lymphadenectomy are improving, leading to a shift in outcomes of interest from survival to postoperative outcomes... (Review)
Review
BACKGROUND
Survival rates after a total gastrectomy with adequate lymphadenectomy are improving, leading to a shift in outcomes of interest from survival to postoperative outcomes and symptoms. In this systematic review, we investigate gastrointestinal symptoms that occur after a gastrectomy in relation to exocrine pancreatic insufficiency and the effect of pancreatic exocrine enzyme supplementation on these symptoms.
METHODS
Online databases PubMed, Embase, and Cochrane Library were systematically searched in accordance with the PRISMA guidelines. Studies that researched gastrointestinal symptoms, exocrine pancreatic function, and enzyme supplementation were identified and assessed.
RESULTS
The search resulted in a total of 1,023 articles after exclusion of duplicates. After performing a thorough assessment, 4 studies were included for systematic review. Exocrine pancreatic insufficiency was investigated by 2 studies; the results showed a significant decrease of total exocrine pancreatic function of up to 76%. The other 2 studies investigated the effect of pancreatic enzyme supplementation and found minor improvement in fecal consistency and a decrease in high-degree steatorrhea. No differences in individual symptom scores were reported.
CONCLUSION
Gastrointestinal symptoms such as steatorrhea, bloating, and dumping syndrome may be related to exocrine pancreatic function, initiated by total gastrectomy. Treatment with pancreatic enzymes had a minor positive effect on patients. It should be noted that these studies were of a small sample size and low quality. New and larger RCTs are necessary to either prove or disprove the benefit of pancreatic enzyme replacement therapy in the treatment of the gastrointestinal symptoms after total gastrectomy.
Topics: Dietary Supplements; Enzyme Therapy; Exocrine Pancreatic Insufficiency; Gastrectomy; Humans; Steatorrhea; Stomach Neoplasms
PubMed: 28315875
DOI: 10.1159/000454958 -
Journal of Laparoendoscopic & Advanced... Oct 2014Pylorus-preserving gastrectomy (PPG) has been performed to reduce postprandial symptoms for some early gastric cancer (EGC) cases. The aim of this study was to evaluate... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Pylorus-preserving gastrectomy (PPG) has been performed to reduce postprandial symptoms for some early gastric cancer (EGC) cases. The aim of this study was to evaluate the possible advantages after PPG for middle-third EGC in comparison with distal gastrectomy.
MATERIALS AND METHODS
We searched Medline, Embase, and Science Citation Index Expanded for relevant studies. Statistical analyses were conducted to calculate the summary weighted mean differences (WMDs) and odds ratios (ORs) with corresponding 95% confidence intervals (95% CIs) using random-effects models.
RESULTS
We identified 15 nonrandomized controlled trials (16 studies) with 1774 patients, which consisted of 11 studies for conventional PPG (CPPG) versus conventional distal gastrectomy (CDG) and 5 studies for laparoscopy-assisted PPG (LAPPG) versus laparoscopy-assisted distal gastrectomy (LADG). Meta-analysis of CPPG versus CDG revealed that CPPG had the advantage of prevention of early dumping syndrome (OR=0.18; 95% CI 0.12, 0.27), gastritis (OR=0.19; 95% CI 0.07, 0.53), duodenal juice reflux (OR=0.20; 95% CI 0.06, 0.66), and regaining of weight (WMD=3.53; 95% CI 2.34, 4.72). However, the incidence of gastric stasis was higher in the CPPG group than in the CDG group (OR=1.70; 95% CI 1.13, 2.57). Meta-analysis of LAPPG versus LADG revealed that LAPPG shortened the operation time (WMD=-21.12; 95% CI -31.33, -10.90) and did not increase the occurrence of postoperative complication (OR=0.72; 95% CI 0.41, 1.27).
CONCLUSIONS
With the benefits of prevention of early dumping syndrome, duodenal juice reflux, gastritis, and regaining of weight, PPG can be an excellent option for middle-third EGC.
Topics: Adenocarcinoma; Controlled Clinical Trials as Topic; Female; Gastrectomy; Gastroenterostomy; Humans; Laparoscopy; Male; Organ Sparing Treatments; Postoperative Complications; Pylorus; Stomach Neoplasms; Weight Gain
PubMed: 25243417
DOI: 10.1089/lap.2014.0123 -
Journal of Clinical Medicine Research Oct 2017In patients with late dumping syndrome following gastrectomy, it has been reported that hypoglycemia occurs due to inhibition of glucagon secretion as a result of...
BACKGROUND
In patients with late dumping syndrome following gastrectomy, it has been reported that hypoglycemia occurs due to inhibition of glucagon secretion as a result of excessive insulin production facilitated by an increase in glucagon-like peptide-1 (GLP-1).
METHODS
To determine the kinetics of incretins in Japanese patients with late dumping syndrome, an oral glucose tolerance test was carried out before and after miglitol administration, and the kinetics of insulin and incretins were analyzed.
RESULTS
After miglitol administration, there was improvement of hypoglycemia and early phase insulin secretion, with persistent excessive insulin secretion being minimized. These findings revealed that miglitol inhibited rapid excessive influx of carbohydrates into the blood and persistent elevation of GLP-1, resulting in improvement of early phase insulin secretion and minimizing persistent excessive insulin secretion.
CONCLUSIONS
Eating frequent small meals is generally effective for late dumping syndrome, but patients often find it difficult to continue such a regimen. Based on the present analysis of incretin kinetics, miglitol may be a useful treatment option for late dumping syndrome.
PubMed: 28912925
DOI: 10.14740/jocmr3135w -
Surgery For Obesity and Related... Sep 2019Postprandial hypoglycemia and early dumping syndrome are common complications after bariatric surgery. Although sleeve gastrectomy (SG) has become a primary option for...
BACKGROUND
Postprandial hypoglycemia and early dumping syndrome are common complications after bariatric surgery. Although sleeve gastrectomy (SG) has become a primary option for many bariatric surgeons, limited information was available for the prevalence and risk factors of the complications.
OBJECTIVE
To assess the prevalence and possible risk factors for postprandial hypoglycemia and early dumping syndrome based on self-reported symptoms of SG patients.
SETTING
The study was conducted at a bariatric surgery center in a university hospital.
METHODS
In this study, all patients who underwent an SG (n = 222) between December 2011 and May 2018 in our center were invited to participate in a questionnaire survey. The Edinburgh Hypoglycemia Scoring System and the Dumping Symptom Rating Scale were used to evaluate symptoms, and clinical data of the patients were collected. The median follow-up time was 1.1 years.
RESULTS
The questionnaire was completed and returned by 54.95% (122/222) of the patients and 62.30% (76/122) of the responders were women. The prevalence rates of mild and moderate symptoms suggestive of hypoglycemia were 65.57% (80/122) and .82%, respectively. An associated risk factor was younger age (adjusted for sex, body mass index, and waist circumference at baseline: odds ratio 3.69; 95% confidence interval [1.22-11.21]), but this association disappeared after further adjustment of low-density protein cholesterol (LDL-C) (odds ratio 6.42; 95% confidence interval [.38-108],;P > .05). The prevalence rate of mild symptoms suggestive of early dumping was 40.98% (50/122), associated risk factor was lower LDL-C.
CONCLUSION
Mild-to-moderate symptoms suggestive of hypoglycemia and early dumping syndrome were common in patients after SG, with the prevalence rates of 66.39% (81/122) and 40.98% (50/122), respectively. Patients with both symptoms suggestive of early dumping syndrome and hypoglycemia accounted for 33.61% (41/122) of all patients. Younger age indicated higher risk of hypoglycemia after SG and lower LDL-C may play an important role in this relationship. Lower LDL-C was associated with higher risk of early dumping syndrome after SG.
Topics: Adult; Dumping Syndrome; Female; Gastrectomy; Humans; Hypoglycemia; Male; Obesity, Morbid; Postoperative Complications; Prevalence; Risk Factors; Self Report; Symptom Assessment; Young Adult
PubMed: 31427225
DOI: 10.1016/j.soard.2019.06.026 -
Surgical Endoscopy Jun 2022Dumping syndrome is a known complication of Roux-en-Y gastric bypass (RYGB). Recently, endoscopic gastrojejunal anastomosis (GJA) revision has been employed as a... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Dumping syndrome is a known complication of Roux-en-Y gastric bypass (RYGB). Recently, endoscopic gastrojejunal anastomosis (GJA) revision has been employed as a treatment option. The primary aim of this study was to perform a systematic review and meta-analysis for the role of endoscopic GJA revision in patients with RYGB for the treatment of dumping syndrome.
METHODS
Search strategies were developed for PubMed, EMBASE, Web of Science, and Cochrane Library databases from inception through December 2020 in accordance with PRISMA and MOOSE guidelines. Pooled proportions with rates estimated using random effects models were used. Outcomes included pooled technical success, clinical success, adverse events, and rate of reintervention. Heterogeneity was assessed with I statistics and publication bias by funnel plot using Egger and Begg tests.
RESULTS
Six studies (n = 263 patients; 60.25% female) were included (1 prospective and 5 retrospective). Mean age was 46.27 ± 2.54 years. Average patient weight was 95.59 ± 4.78 kg, BMI of 41.43 ± 3.07 kg/m, and pre-procedure GJA size of 32.23 ± 8.68 mm. Pooled technical and clinical success was 98.15% and 89.5%. Among studies reporting Sigstad scores, endoscopic GJA revision resulted in a significant improvement [mean Sigstad score difference of - 9.96 (95% CI, - 19.951 to - 0.975); P < 0.03]. Mean procedure time was 37.12 ± 10.40 min with an intra-procedural adverse event rate of 2.42%. Over a mean follow-up of 8.03 ± 6.87 months, post-procedure adverse events occurred in 2.96% of patients with a reintervention rate of 11.54%.
CONCLUSION
This systematic review and meta-analysis suggests that endoscopic GJA revision appears an effective and safe treatment for dumping syndrome.
Topics: Anastomosis, Roux-en-Y; Dumping Syndrome; Female; Gastric Bypass; Humans; Male; Obesity, Morbid; Prospective Studies; Reoperation; Retrospective Studies; Treatment Outcome
PubMed: 34669046
DOI: 10.1007/s00464-021-08731-4 -
Annals of Surgery Open : Perspectives... Mar 2022Late dumping syndrome is a common postgastrectomy complication characterized by reactive hypoglycemia. This study aimed to explore the glycemic trend in patients who...
OBJECTIVE
Late dumping syndrome is a common postgastrectomy complication characterized by reactive hypoglycemia. This study aimed to explore the glycemic trend in patients who underwent gastrectomy for gastric cancer and clarify its changes over time in association with postgastrectomy symptoms.
SUMMARY BACKGROUND DATA
Changes over time in glycemic trend in association with postgastrectomy symptoms have not been evaluated.
METHODS
We conducted a prospective study of 71 patients who underwent curative gastrectomy for gastric cancer between November 2017 and April 2020. The patients underwent continuous glucose monitoring twice-at 1- and 12-month postgastrectomy-and were assessed using the Post-Gastrectomy Syndrome Assessment Scale 37-item questionnaire (PGSAS-37) at 1-, 6-, and 12-month postgastrectomy.
RESULTS
Our results revealed that hypoglycemia (<70 mg/dL), especially nocturnal hypoglycemia (00:00-06:00), frequently occurred even at 12-month postgastrectomy. Hypoglycemia improved in total gastrectomy patients but remained unchanged in distal gastrectomy patients, which was still high in both groups at 12-month postgastrectomy. Glycemic variability (SD of the glycemic trend) was exacerbated in both gastrectomy groups. However, the PGSAS-37 symptom scores remained unchanged, and the living status and quality of life tended to improve. Hypoglycemia unawareness, including postprandial hypoglycemia without symptoms and nocturnal hypoglycemia, was evident even 12-month postgastrectomy.
CONCLUSIONS
Persistent postgastrectomy hypoglycemia unawareness, including late dumping syndrome without symptoms and nocturnal hypoglycemia, should be recognized as an important issue in postgastrectomy syndrome. Therefore, meticulous long-term evaluation for glycemic trends and care of patients is required.
PubMed: 37600103
DOI: 10.1097/AS9.0000000000000135