Early Dumping Research Articles

Predictors and weight impact of postbariatric hypoglycemia after Roux-en-Y gastric bypass surgery: a prospective observational cohort study

BackgroundPostbariatric hypoglycemia (PBH) is a challenging condition affecting quality of life of patients after bariatric surgery. However, its incidence and predictive factors remain debated. ObjectivesTo determine the incidence of PBH, identify predictors of PBH and assess its association with weight trajectory after bariatric surgery. SettingUniversity Hospital. MethodsProspective observational cohort study including 222 nondiabetic patients who underwent Roux-en-Y gastric bypass between 2014 and 2021, had an oral glucose tolerance test (OGTT) and/or A1C (glycated hemoglobin) measurement prior to surgery and were followed for at least 12 months. Diagnosis of PBH was made when symptoms of hypoglycemia were accompanied by a postprandial plasma glucose level < 3.9 mmol/l or a glycemia < 3.9 mmol/l during continuous glucose monitoring, with resolution of symptomatology after carbohydrate consumption. Univariable and multivariable logistic regression analyses were performed to identify factors associated with PBH. ResultsOut of 222 patients, 71 (32%) were diagnosed with PBH. The highest incidence rate was observed at 2 years postbariatric surgery with a cumulative incidence of 26.5%. Predictive factors for higher risk of PBH were younger age at surgery (OR = .97; 95% CI: .94–.99; P = .049) and early dumping syndrome (OR = 3.05; 95% CI: 1.62–6.04; P = .0008). In multivariable logistic regression, higher glycemia at 2 hours during preoperative OGTT was associated with lower risk of PBH (OR = .8; 95% CI: .63–.98; P = .04). PBH was not associated with weight trajectory after surgery in our cohort. ConclusionsYounger age at time of surgery and lower blood glucose at 120 minute during preoperative OGTT are risk factors for PBH. Early dumping syndrome is significantly associated with PBH and could be used as a red flag to help identify patients at risk of PBH.

OGC P54 Catastrophic dumping after gastrectomy in a patient with absent pituitary treated with octreotide – case report

Abstract Background Gastrectomy results in a profound change in appetite, satiety and response to food. Most people will adapt and manage to maintain adequate enteral nutrition, however severe symptoms can hamper quality of life. Early dumping, defined as noxious symptoms occurring within an hour of food, arises due to a combination of vastly increased satiety gut hormone secretion and fluid shifts. Late dumping (reactive hypoglycaemia) occurs due to enhanced post-prandial incretin hormone secretion. We present a case of severe dumping in a patient with absent pituitary treated with the global counter-regulatory hormone octreotide. Methods A 71-year-old patient with absent pituitary underwent total gastrectomy and oesophago-jejunal anastomosis for a greater curve gastric adenocarcinoma. Post-operatively, the patient developed an overall aversion to eating along with significant nausea and vomiting, diarrhoea, abdominal fullness, and tachycardia. Anti-emetics including droperidol, metoclopramide, and haloperidol yielded limited response. NJ feeding also triggered symptoms and was stopped. Parenteral nutrition was the principal source of diet. A trial of a somatostatin analogue, octreotide, resulted in significant improvement of patient symptoms. A dose increase and then conversion to monthly lanreotide was tolerated well resulting in complete resolution of symptoms and no side effects. Results The pituitary gland and hypothalamus are central to regulating appetite and satiety through complex signalling pathways. Hormone signals, including GLP-1, GIP, PYY and ghrelin act on central circuits within the hypothalamus to modulate intake, gastric emptying, and satiety. With an absent pituitary, these hormonal signalling pathways including somatostatin are disrupted. Octreotide therapy likely works through a combination of central suppression of gut hormone signalling as well as peripheral reduction in gut hormone secretion. Conclusions Dumping syndrome is a multifactorial, quality of life limiting consequence of upper GI resection. In patients with altered central appetite control circuitry the symptoms may be so severe as to prevent any enteral intake, including via NJ tube. Interestingly, considering this an endocrinology problem and acting to suppress all hormonal signalling with octreotide had immediate and enduring success in the presented case. This may represent a route for management of patients with significant dumping symptoms and nutritional compromise after gastrectomy or oesophagectomy.

Incidence and Intensity of Early Dumping Syndrome and Its Association with Health-Related Quality of Life Following Sleeve Gastrectomy.

Dumping syndrome (DS) is a shared but underappreciated complication after metabolic-bariatric surgery. The purpose of the study was to investigate the prevalence and intensity of symptoms suggestive of DS and their relationship with health-related quality of life (HRQOL) after laparoscopic sleeve gastrectomy (LSG). A retrospective cohort study was performed for all patients with a history of sleeve gastrectomy between July 2017 and July 2022 in our center. Basial clinic statistics were gathered from electronic medical database, the prevalence and severity of DS were assessed by Dumping Symptom Rating Scale (DSRS), and HRQOL is collected through the Short Form Health Survey 36 (SF-36). In total, 133 of 202 patients completed the questionnaire (response rate 65.8%). A total of 64.7% (N = 86) of participants were female, aged 34.0 (IQR 26.0-39.0) years at completion of the questionnaire, with a mean body mass index of 35.8 (IQR 31.4-40.5) kg/m2. The prevalence of symptoms suggestive of DS was 45.9% (N = 61), and the associated protective factor was the time between surgery and study. Compared with the patients without DS, patients with DS scored significantly worse on four of eight SF-36 subdomains. Symptoms suggestive of early dumping syndrome after sleeve gastrectomy are common and are associated with a worse health-related quality of life, which deserves clinical attention. Additional counselling, education, and care are needed to mitigate the decline in quality of life caused by dumping symptoms.

Reliability of the DSS-Swe Questionnaire

BackgroundSymptomatic postbariatric hypoglycemia (PBH) is a known complication that can occur a few years after Roux-en-Y gastric bypass (RYGB). There is currently no established rating scale for PBH-associated symptoms developed for use in Swedish populations. The aim of the study was to translate an already existing questionnaire into Swedish and to test its reliability.MethodsThe study included forward and backward translations of the original Dumping Severity Scale (DSS) questionnaire with 8 items regarding symptoms of early dumping and 6 items regarding hypoglycemia, with each item graded on a 4-point Likert scale. The reliability of the Swedish translated questionnaire (DSS-Swe) was estimated using internal consistency and test–retest methods.ResultsA total of 200 patients were included in the study. Good internal consistency was demonstrated regarding the items related to early dumping symptoms, with a Cronbach’s alpha coefficient of 0.82, and very good agreement in terms of test–retest reliability, with an overall intraclass correlation coefficient (ICC) of 0.91 (95% CI 0.88–0.93). The items related to hypoglycemia yielded a good Cronbach’s alpha coefficient of 0.76 and an ICC of 0.89 (95% CI 0.85–0.91).ConclusionThe DSS-Swe questionnaire shows good reliability regarding both internal consistency and test–retest performance for use in Swedish populations.Graphical

FRI612 Tirzepatide For The Treatment Of Post-bariatric Surgery Hypoglycemia And Early Dumping Syndrome

Abstract Disclosure: E.F. Stortz: None. H.M. Lawler: Research Investigator; Self; VogenX. Background: Post-bariatric hypoglycemia (PBH) is a challenging condition with limited treatment options. Glucagon-like peptide 1 (GLP-1) receptor agonists have been used with mixed success. To our knowledge, there have been no reported cases of PBH treatment with dual incretin agonist medications. We describe a case in which tirzepatide was successfully used to improve both post-bariatric surgery hypoglycemia as well as symptoms of early dumping syndrome. Clinical Case: A 46-year-old woman with prediabetes presented with labile blood sugars, post-prandial hypoglycemia, and intermittent severe bloating with diarrhea shortly after eating meals. She had a past medical history of gastric banding 16 years ago, resulting in a 70 pound weight loss. Her post-operative course was complicated by post-meal retching and vomiting for many years. She subsequently had gastric band reversal with concurrent sleeve gastrectomy 2 years ago. While her vomiting improved, she experienced intermittent post-meal bloating and diarrhea. About 8 months after this surgery, she developed symptoms of hypoglycemia after meals, with glucometer readings of 30-49 mg/dL. Continuous glucose monitoring (CGM) for 1 week prior to therapy revealed a time in range (70-180 mg/dL) of 90%, 3-4% time above 180 mg/dL, and 6-7% time below 70 mg/dL. Dietary changes did not help improve hypoglycemic episodes or her dumping symptoms. She initially started tirzepatide 2.5mg weekly and noticed improvement in both symptoms. Her dose increased to 5mg weekly, and she had near complete resolution in her post-prandial hypoglycemia. Upon review of 1 week of CGM data, her time in range improved to 96% with 2% time above 180 mg/dL and 0% time below 70 mg/dL. Her glucose peak was 224 with a nadir of 72. Her early dumping symptoms also improved, occurring only with very high-carb meals. Conclusion: Many pharmacotherapies have sought to improve post-bariatric surgery hypoglycemia with limited success often significant side effects. The post-prandial peak of GLP-1 levels tends to be higher in patients after bariatric surgery compared to obese controls, possibly playing a role in the condition’s pathophysiology. Studies of glucose-dependent insulinotropic peptide (GIP) in patients after bariatric surgery exhibit mixed trends. Numerous case reports have shown successful treatment of PBH with GLP-1 receptor agonists, while other have shown no clear benefit. It is possible that dual incretin therapy may attenuate more of the post-prandial hyperinsulinemic-hypoglycemic response in ways that are incompletely understood and requires further investigation. Interestingly, this case showed that tirzepatide administration not only resulted near-resolution of post-prandial hypoglycemia, but it also improved this patients’ early dumping syndrome symptoms. Presentation: Friday, June 16, 2023

Dumping syndrome after bariatric surgery: prevalence, pathophysiology and role in weight reduction - a systematic review.

Dumping syndrome is a frequent and wellknown adverse event after bariatric surgery and covers a dynamic spectrum of early and late dumping. Accelerated gastric emptying is generally considered to be the cause of gastrointestinal and vasomotor complaints. However, there is much uncertainty regarding the exact pathophysiology of dumping. It has been speculated that the syndrome is a desired consequence of bariatric surgery and contributes to more efficient weight loss, but supporting data are scarce. A systematic search was conducted in PubMed in July-August 2021. The prevalence of dumping after the most frequently performed bariatric procedures was analyzed, as well as underlying pathophysiology and its role in weight reduction. Roux-en-Y gastric bypass (RYGB) is associated with the highest postoperative prevalence of dumping. The fast transit induces neurohumoral changes which contribute to an imbalance between postprandial glucose and insulin levels, resulting in hypoglycemia which is the hallmark of late dumping. Early dumping can, when received in a positive way, become a tool to maintain a strict dietary pattern, but no significant relationship to the degree of weight loss has been shown. However, late dumping is detrimental and promotes overall higher caloric intake. Dumping syndrome is common after bariatric surgery, especially after RYGB. The pathophysiology is complex and ambiguous. Currently available data do not support dumping as a necessary condition to induce weight loss after bariatric surgery.

A Case Study of a Dumping Syndrome Patient Treated with &lt;italic&gt;Gamchobunmil-tang&lt;/italic&gt;

The purpose of this study is to explore the effectiveness of &lt;i&gt;Gamchobunmil-tang&lt;/i&gt; as a treatment for early dumping syndrome. A patient reported abdominal pain after eating, was not able to eat more than two spoons of thin rice gruel, and had lost 8 kg of his weight. The patient was treated with &lt;i&gt;Gamchobunmil-tang&lt;/i&gt; three times a day for 12 days. The effects of the treatment were evaluated using the Visual Analogue Scale and the amount and form of the patient’s intake. After treatment, the pain due to the dumping syndrome decreased. The Visual Analogue Scale score dropped significantly from 9 to 2, and increased amounts and novel forms of the food the patient consumed were observed. Despite the lack of a case, the results showed that &lt;i&gt;Gamchobunmil-tang&lt;/i&gt; was effective in reducing the pain caused by the early dumping syndrome. Further research might prove that &lt;i&gt;Gamchobunmil-tang&lt;/i&gt; could be an alternative treatment method for early dumping syndrome.

A case of insulinoma confused with dumping syndrome after total gastrectomy

We present the case of a 70-year-old female patient with persistent hypoglycemia after total gastrectomy due to gastrointestinal stromal tumors. She was thought to have late dumping syndrome but was diagnosed with insulinoma after further examination. Dumping syndrome is mainly seen after stomach or esophageal surgery. It is divided into early dumping and late dumping syndrome. Late dumping syndrome is initially manifested by an exaggerated insulin response and reactive hypoglycemia after glucagon-like peptide-1 release. Diagnosis is based on clinical findings. Treatment mainly consists of reducing carbohydrate intake and not ingesting solid and liquid foods together. In cases where diet alone is not sufficient, acarbose, an α-glucosidase inhibitor that slows the digestion of carbohydrates, may be beneficial for late dumping. Octreotide can be used in resistant cases. However, the diagnosis of insulinoma, which leads to a similar clinical presentation in resistant dumping cases, should be kept in mind. Our patient who showed clinical signs of dumping syndrome after gastrectomy, and treatment-resistant hypoglycemia was diagnosed with insulinoma on the basis of further investigations. The patient’s symptoms resolved after surgery for insulinoma.

Preliminary prospective study of real-time post-gastrectomy glycemic fluctuations during dumping symptoms using continuous glucose monitoring.

BACKGROUNDAlthough dumping symptoms constitute the most common post-gastrectomy syndromes impairing patient quality of life, the causes, including blood sugar fluctuations, are difficult to elucidate due to limitations in examining dumping symptoms as they occur.AIMTo investigate relationships between glucose fluctuations and the occurrence of dumping symptoms in patients undergoing gastrectomy for gastric cancer.METHODSPatients receiving distal gastrectomy with Billroth-I (DG-BI) or Roux-en-Y reconstruction (DG-RY) and total gastrectomy with RY (TG-RY) for gastric cancer (March 2018-January 2020) were prospectively enrolled. Interstitial tissue glycemic profiles were measured every 15 min, up to 14 d, by continuous glucose monitoring. Dumping episodes were recorded on 5 patient-selected days by diary. Within 3 h postprandially, dumping-associated glycemic changes were defined as a dumping profile, those without symptoms as a control profile. These profiles were compared.RESULTSThirty patients were enrolled (10 DG-BI, 10 DG-RY, 10 TG-RY). The 47 early dumping profiles of DG-BI showed immediately sharp rises after a meal, which 47 control profiles did not (P < 0.05). Curves of the 15 late dumping profiles of DG-BI were similar to those of early dumping profiles, with lower glycemic levels. DG-RY and TG-RY late dumping profiles (7 and 13, respectively) showed rapid glycemic decreases from a high glycemic state postprandially to hypoglycemia, with a steeper drop in TG-RY than in DG-RY. CONCLUSIONPostprandial glycemic changes suggest dumping symptoms after standard gastrectomy for gastric cancer. Furthermore, glycemic profiles during dumping may differ depending on reconstruction methods after gastrectomy.

Postoperative dumping-syndrome with relevant impairment ofglucose homeostasis - relief by continuous glucose monitoring and individual therapy with GLP-1 receptor agonists

Dumping syndromes are a common side effect after partial or total gastric resection. The symptoms may be diverse, with vasomotoric reactions, collapse tendencies and digestive disorders (early dumping) as well as blood sugar derailment as a result of too fast absorption of glucose (late dumping).Entrenched therapy concepts, including personalized nutritional concepts and the use of medication as octreotide or diazoxide, will not always lead to the desired results. It is then, that individual therapy concepts have to be found to restore the patient's quality of life, as shown in this case study.

Dumping Syndrome and Postbariatric Hypoglycemia: Supporting Evidence for a Common Etiology.

Dumping syndrome (DS) and postbariatric hypoglycemia (PBH) are frequent complications of bariatric surgery. Previously known as "early and late dumping," these complications have been separated due to differences in their onset and behaviors. To investigate a potentially common etiology of DS and PBH using an analysis of a mixed meal test (MMT) study. A large teaching hospital in the Netherlands. From all patients who underwent bariatric surgery in 2008-2011, a random selection completed an MMT (n = 47). Patients scored complaints related to DS and PBH with a standardized questionnaire at several time intervals. The groups were divided into patients with (DS+; n = 22) and without (DS-; n = 25) an increase in DS symptoms after the start of the MMT. Glucose and gut hormone levels were compared. Hypoglycemia was defined as a blood glucose level below 3.3 mmol/L. The DS+ group had lower blood glucose values compared to the DS- group, which reached significance at 90 and 120 minutes (P < .05). For the DS+ group, glucagon-like peptide-1 (GLP-1), peptide YY (PYY), and satiety were higher at various time intervals (P < .05) compared to the DS- group. No differences were found for insulin and hunger score. GLP-1 and PYY were correlated with symptoms of DS. Patients with DS complaints had lower postprandial glucose values. GLP-1 and PYY values were elevated in the DS+ group early and late during the test. These hormones also correlated with DS. These findings support the hypothesis of a common etiology of DS and PBH and a role of GLP-1 and PYY in both complications.

A Case Report of Korean Medicine Treatment for a Patient with Early Dumping Syndrome with Diarrhea and Abdominal Pain after Gastrectomy

A Case Report of Korean Medicine Treatment for a Patient with Early Dumping Syndrome with Diarrhea and Abdominal Pain after Gastrectomy

Prevalence and intensity of dumping symptoms and their association with health-related quality of life following surgery for oesophageal cancer

This study aimed to investigate the prevalence and intensity of symptoms of dumping syndrome (early and late) experienced by oesophageal cancer survivors one year after surgery and their association with health related quality of life (HRQL). A prospective cohort study of patients who underwent surgery for oesophageal cancer in Sweden from January 2013 to April 2018, included at one year after surgery with follow-up at 1.5 years. Common symptoms of dumping syndrome were the exposure, classified as early and late onset, further divided into 'moderate' or 'severe' based on symptom intensity, and no dumping symptoms (reference group). The primary outcome was mean summary score of HRQL, and secondary outcomes were global quality of life, physical, role, emotional, cognitive and social function measured using the EORTC QLQ-C30 1.5 years after surgery. An ANCOVA model, adjusted for potential confounders was used to study the association between dumping symptoms and HRQL, presented as mean score differences (MD) with 95% confidence intervals (CI). Among 188 patients, moderate early dumping symptoms was experienced by 45% and severe early dumping by 9%. Moderate late dumping symptoms was reported by 13%, whereas 5% reported severe late dumping symptoms. Severe early dumping symptoms was associated with worse HRQL in 4 out of 7 aspects with worse global quality of life (MD-16, 95% CI:-27 to-4) and social function (MD-17, 95% CI:-32 to-3), which showed clinically large differences compared to having no such symptoms. Patients with moderate late dumping symptoms reported poorer HRQL in 6 out of 7 aspects compared to those with no dumping symptoms. Cognitive function (MD-27, 95% CI:-47 to-7) and emotional function (MD-24, 95% CI:-47 to-2) were significantly declined (clinically large relevance) in those with severe late dumping symptoms. Patients who have undergone curative treatment for oesophageal cancer experience reduced HRQL from early and late dumping symptoms at one year after surgery that indicate clear implications for clinical routine. Medical support and additional dietary counselling are required as potential ways to alleviate dumping symptoms on clinical repercussions.

A comparison between pylorus-preserving and distal gastrectomy in surgical safety and functional benefit with gastric cancer: a systematic review and meta-analysis

BackgroundDue to better functional outcomes, pylorus-preserving gastrectomy (PPG) has been widely applied for early gastric cancer (EGC) patients as an alternative to distal gastrectomy (DG). However, controversies still persist regarding the surgical efficacy and oncological safety of PPG.MethodsOriginal studies comparing PPG and DG for EGC were searched in PubMed, Embase, and the Cochrane Register of Controlled Trials up to December 2019. The weight mean difference, standardized mean difference, or odds risk was used to calculate the short-term and long-term outcomes between the two groups.ResultsTwenty-one comparative studies comprising 4871 patients (1955 in the PPG group and 2916 in the DG group) were enrolled in this systematic review and meta-analysis. PPG showed longer hospital day, decreased harvested lymph nodes, and more delayed gastric emptying. However, PPG had the benefits of lower incidence of anastomosis leakage, early dumping syndrome, gastritis and bile reflux, and better recovery of total protein, albumin, hemoglobin, and weight. No difference was found in operative time, blood loss, and overall complications. Moreover, the long-term survival and recurrence rate were similar in two groups.ConclusionOwing to the non-inferiority of surgery and oncology outcomes and the superiority of function outcomes in PPG, we revealed that PPG can be clinically applicable instead of DG in EGC. However, more high-quality comparative studies and randomized clinical trials would be required for further confirmation.

Roux-en-Y Gastric Bypass Reversal: A Novel Technique With Functional Reversal - Case Series.

Reversal of Roux-en-Y gastric bypass (RYGB) to normal anatomy (NA) is mandated in selected cases. However, reversal operations are associated with high complication rates and long operative times. In this study, we present the functional reversal (FR) as a novel method and an alternative to reversal to NA in treating the otherwise intractable symptoms rarely occurring after RYGB. This is a retrospective cohort study of RYGB-patients with symptoms resistant to non-surgical treatment. Placement of gastrostomy tube for surgical evaluation and optimization of patients was usually done before FR. Resolution of symptoms was assessed along with efficacy and safety of the procedure. Achieved results were compared with data from the literature pertaining to reversal to NA. High-volume bariatric center, Norway. Ten patients underwent FR. Mean follow-up after reversal was 18.4months. Symptoms leading to operation improved in all patients. Eight patients suffered from hypoglycemia; resolution was seen in six and improvement of symptoms in the remaining two. Food intolerance, early dumping, nausea, postprandial abdominal pain, and malnutrition were alleviated in all patients. One leak was seen. Mean surgical time was 35.2min. Total weight loss (TWL) and excess weight loss (EWL) after index RYGB were reduced 4.5% and 17.8%. Functional reversal looks promising as an alternative to reversal to normal anatomy as it is technically simpler and safer and seems at least as effective in treating otherwise refractory symptoms.

Evidence for Relationship Between Early Dumping and Postprandial Hypoglycemia After Roux-en-Y Gastric Bypass.

Early dumping and post-bariatric hypoglycemia (PBH) are often addressed as two separate postprandial complications after Roux-en-Y gastric bypass (RYGB). The aim of the study was to evaluate the occurrence of early dumping in RYGB-operated individuals with PBH with and without treatment intervention. Eleven RYGB-operated women with documented PBH each underwent a baseline liquid mixed meal test (MMT) followed by five MMTs preceded by treatment with: acarbose 50mg for 1week, sitagliptin 100mg for 1week, verapamil 120mg for 1week, liraglutide 1.2mg for 3weeks, and pasireotide 300μg as a single dose. Repetitive venous blood sampling and continuous electrocardiogram recordings were performed at fasting and during a 3-h postprandial period. During the baseline MMT, there was a significant increase in HR (from 65 ± 2 to 90 ± 4bpm, p < 0.0001) within 30min after meal intake, while hypoglycemia occurred in the later postprandial period. The HR increase was accompanied by significant increases in serum albumin, plasma norepinephrine, blood glucose, serum insulin, and plasma GLP-1 concentrations. The postprandial HR changes were positively correlated with the changes in insulin and GLP-1 concentrations. Treatment with acarbose and pasireotide both reduced HR, plasma norepinephrine, and serum insulin, and pasireotide also decreased plasma GLP-1. RYGB-operated individuals with PBH also have large early postprandial HR increases, hemoconcentration, and sympathetic activation, consistent with early dumping. Moreover, hormone excursions associated with PBH appear to be related to measures of early dumping, suggesting a causal relationship between early dumping and PBH. NCT02527993.

Postprandial Changes in Gastrointestinal Hormones and Hemodynamics after Gastrectomy in Terms of Early Dumping Syndrome.

PurposeThis study aimed to examine the early postprandial changes in gastrointestinal (GI) hormones and hemodynamics in terms of early dumping syndrome after gastrectomy for gastric cancer.Materials and MethodsForty patients who underwent gastrectomy for gastric cancer and 18 controls without previous abdominal surgery were enrolled. Before and 20 minutes after liquid meal ingestion, blood glucose, glucagon-like peptide-1 (GLP-1), and GLP-2 concentrations and superior mesenteric artery (SMA) and renal blood flow were measured. The patients' heart rates were recorded at 5-minute intervals. All subjects were examined for dumping syndrome using a questionnaire based on Sigstad's clinical diagnostic index.ResultsThe postprandial increases in blood glucose, GLP-1, and GLP-2 levels as well as SMA blood flow and heart rate were greater in patients who underwent gastrectomy than in controls (all P<0.010). Patients who underwent gastrectomy showed a significantly decreased renal blood flow (P<0.001). Among patients who underwent gastrectomy, distal gastrectomy was a significant clinical factor associated with a lower risk of early dumping syndrome than total gastrectomy (hazard ratio, 0.092; 95% confidence interval, 0.013–0.649; P=0.017). Patients who underwent total gastrectomy showed a greater postprandial increase in blood glucose (P<0.001), GLP-1 (P=0.030), and GLP-2 (P=0.002) levels as well as and heart rate (P=0.013) compared to those who underwent distal gastrectomy.ConclusionsEarly postprandial changes in GI hormones and hemodynamics were greater in patients who underwent gastrectomy than in controls, especially after total gastrectomy, suggesting that these changes play a crucial role in the pathophysiology of early dumping syndrome.

Prevalence and risk factors for symptoms suggestive of hypoglycemia and early dumping syndrome after sleeve gastrectomy

BackgroundPostprandial 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. ObjectiveTo assess the prevalence and possible risk factors for postprandial hypoglycemia and early dumping syndrome based on self-reported symptoms of SG patients. SettingThe study was conducted at a bariatric surgery center in a university hospital. MethodsIn 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. ResultsThe 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. ConclusionMild-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.

2073-P: Are Early Dumping and Postprandial Hypoglycemia after Roux-en-Y Gastric Bypass Related Events?

Introduction: Early dumping (ED) and postprandial hypoglycemia (PH) are often addressed as two separate complications after Roux-en-Y gastric bypass (RYGB) although symptoms overlap. We investigated the occurrence of ED in RYGB-patients with PH and potential mechanisms. Methods: In a randomized cross-over study, 11 RYGB-patients with confirmed PH (blood glucose &amp;lt;3.9 mmol/L) underwent 6 separate 4-hour liquid mixed meal tests (MMT) in which continuous heart rate (HR) was recorded by Holter monitoring. The MMTs were preceded by the following: acarbose 50 mg (A), sitagliptin 100 mg (S), verapamil 120 mg (V), liraglutide 1.2 mg s (L), pasireotide 300 µg (P) and no treatment (NT). HR was averaged over 5 minutes intervals and calculated as peak values and incremental changes from baseline (ΔHR). ED was diagnosed as ΔHR ≥10 bpm during the first 60 minutes of the MMT. Associations between HR values and glucose, insulin, and GLP-1 concentrations were tested with the Spearman rank-order correlation and the effects of drug intervention were tested by use of linear mixed models. Results: With NT, all patients had ΔHR ≥ 15 bpm within the first 35 minutes of the MMT (27 ± 3 bpm, mean ± SEM) corresponding to a 44 ± 4% increase in HR. Peak HR occurred at the same time as peak levels of glucose and GLP-1 (26 ± 2, 31 ± 2, 30 ± 2 minutes; p&amp;gt;0.23) and HR values were positively correlated with glucose, insulin and GLP-1 concentrations (r=0.44, r=0.41, r=0.56; p&amp;lt;0.0001). Intervention with P reduced both ΔHR, insulin and GLP-1 levels, A reduced ΔHR, hyperglycemia and insulin levels, and V reduced ΔHR and peak GLP-1 values (ΔHR: A 18 ± 3, V 18 ± 2, and P 11 ± 2 vs. NT 27 ± 3 bpm; p&amp;lt;0.001). Conclusion: RYGB-patients with PH have postprandial HR increments suggestive of ED, indicating that PH and ED constitute a combined post-surgical complication. Insulin and GLP-1 are potential mediators driving the HR increments. Disclosure C. Øhrstrôm: None. D. Worm: None. U. Kielgast: Advisory Panel; Self; Novo Nordisk A/S. Consultant; Self; Eli Lilly and Company, Sanofi. J.J. Holst: Advisory Panel; Self; Novo Nordisk A/S. D.L. Hansen: None.

Quality of life in patients with upper GI malignancies managed by a strategy of chemoradiotherapy alone versus surgery

Background and objectivesNeoadjuvant chemoradiotherapy (nCRT) induces a pathological complete response (pCR) in 25–85% of oesophago-gastric cancer. As surgery entails morbidity and mortality risks and quality of life (QL) impairment, its avoidance in patients without residual disease is desirable.This study aimed to compare quality of life of patients with a cCR who chose surveillance with those who chose surgery. MethodsFour groups of patients were studied. Group 1(n = 31) were controls; Group 2 (n = 26) had chemoradiotherapy only; Group 3 (n = 31) had oesophagectomy after nCRT; Group 4 (n = 26) had gastrectomy alone. A 33-point novel questionnaire was administered at two 3 month time points. Participants were also interviewed with a validated questionnaire. ResultsMean(±sd) quality of life scores in cCR patients offered surveillance (28.9 ± 4.5) were superior to patients undergoing oesophagectomy (32.3 ± 58. p=0.042) or gastrectomy (33.19 ± 5.9, p=0.004). This result was replicated in the validated questionnaire (p=0.017). There was a trend towards increased reflux-related respiratory symptoms in the oesophagectomy group (7.3 ± 2.2 vs 6.5 ± 1.9; p=0.396) and towards early dumping (8.2 ± 1.4 vs 7.1 ± 1.; p=0.239) and vagotomy-related symptoms (1.82 ± 0.9 vs 1.4 ± 0.6; p=0.438) in the gastrectomy group. ConclusionsAvoidance of surgery in cCR patients is rewarded with a superior quality of life to those undergoing surgery.