A novel technique of Roux-en-Y gastric bypass reversal for postprandial hyperinsulinemic hypoglycaemia: a case report
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
BACKGROUND: We describe an evaluation of the effects of partial Roux-en-Y gastric bypass (RYGB) reversal on postprandial hyperinsulinaemic hypoglycaemia, insulin and GLP-1 levels. CASE SUMMARY: A 37 year old man was admitted with neuroglycopenia (plasma-glucose 1.6mmol/l) 18 months after RYGB, with normal 72h fasting test and abdominal CT. Despite dietary modifications and medical treatment, the hypoglycaemic episodes escalated in frequency. Feeding by a gastrostomy tube positioned in the gastric remnant did not prevent severe episodes of hypoglycaemia. A modified reversal of the RYGB was performed. Mixed meal tests were done perorally (PO), through the gastrostomy tube 1 (GT1), 4 weeks (GT2) after placement and 4 weeks after reversal (POr), with assessment of glucose, insulin and GLP-1 levels. RESULTS: Plasma-glucose increased to a maximum of 9.6, 5.4, 6.5 and 5.8mmol/l at the PO, GT1, GT2 and POr tests respectively. The corresponding insulin levels were 2939, 731, 725 and 463pmol/l. A decrease of plasma-glucose followed: 2.2, 3.0, 3.9 and 2.9mmol/l respectively and insulin levels were suppressed at 150min: 45, 22, 21 and 14pmol/l, respectively. GLP-1 levels increased in the PO test (60min: 122pmol/l, 21 fold of basal), but was attenuated in the two latter tests (12-23pmol/l at 60min). CONCLUSIONS: Reduction of plasma-glucose, insulin and GLP-1 excursions and symptoms were seen after gastric tube placement and partial RYGB reversal. This attenuation of GLP-1 response to feeding could reflect an adaptation to nutrients.
Date Issued
2016-02-27
Date Acceptance
2016-02-19
Citation
International Journal of Surgery Case Reports, 2016, 21, pp.91-94
ISSN
2210-2612
Publisher
Elsevier: Creative Commons
Start Page
91
End Page
94
Journal / Book Title
International Journal of Surgery Case Reports
Volume
21
Copyright Statement
© 2016 Published by Elsevier Ltd. on behalf of IJS Publishing Group Ltd. This is an open access article
under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Sponsor
ONO Pharmaceuticals Co Ltd
Identifier
http://www.ncbi.nlm.nih.gov/pubmed/26957187
PII: S2210-2612(16)00080-8
Grant Number
N/A
Subjects
Case report
GLP-1
Gastric bypass reversal
Hypoglycaemia
Obesity
Postprandial hyperinsulinemic hypoglycaemia
Roux-en-Y gastric bypass
Clinical Sciences
Publication Status
Published
Date Publish Online
2016-02-27