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A novel technique of Roux-en-Y gastric bypass reversal for postprandial hyperinsulinemic hypoglycaemia: a case report

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Title: A novel technique of Roux-en-Y gastric bypass reversal for postprandial hyperinsulinemic hypoglycaemia: a case report
Authors: Qvigstad, E
Gulseth, HL
Risstad, H
Le Roux, CW
Berg, TJ
Mala, T
Kristinsson, JA
Item Type: Journal Article
Abstract: 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.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.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).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.
Issue Date: 27-Feb-2016
Date of Acceptance: 19-Feb-2016
URI: http://hdl.handle.net/10044/1/30971
DOI: http://dx.doi.org/10.1016/j.ijscr.2016.02.033
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/).
Sponsor/Funder: ONO Pharmaceuticals Co Ltd
Funder's Grant Number: N/A
Keywords: Case report
GLP-1
Gastric bypass reversal
Hypoglycaemia
Obesity
Postprandial hyperinsulinemic hypoglycaemia
Roux-en-Y gastric bypass
Clinical Sciences
Publication Status: Published
Appears in Collections:Department of Medicine (up to 2019)