Effects of Gastrogastric Fistula Repair on Weight Loss and Gut Hormone Levels

Abstract

Weight regain after gastric bypass (GBP) can be associated with a gastrogastric fistula (GGF), in which a channel forms between the gastric pouch and gastric remnant, allowing nutrients to pass through the "old route" rather than bypassing the duodenum. To further understand the mechanisms by which GGF may lead to weight regain, we investigated gut hormone levels in GBP patients with a GGF, before and after repair. Seven post-GBP subjects diagnosed with GGF were studied before and 4months after GGF repair. Another cohort of 22 GBP control subjects without GGF complication were studied before and 1year post-GBP. All subjects underwent a 50-g oral glucose tolerance test and blood was collected from 0-120min for glucose, insulin, ghrelin, PYY3-36, GIP, and GLP-1 levels. Four months after GGF repair subjects lost 6.0 ± 3.9kg and had significantly increased postprandial PYY3-36 levels. After GGF repair, fasting and postprandial ghrelin levels decreased and were strongly correlated with weight loss. The insulin response to glucose also tended to be increased after GGF repair, however no concomitant increase in GLP-1 was observed. Compared to the post-GBP group, GLP-1 and PYY3-36 levels were significantly lower before GGF repair; however, after GGF repair, PYY3-36 levels were no longer lower than the post-GBP group. These data utilize the GGF model to highlight the possible role of duodenal shunting as a mechanism of sustained weight loss after GBP, and lend support to the potential link between blunted satiety peptide release and weight regain.