Early Dumping Research Articles

Prevalence, severity, and predictors of symptoms of dumping and hypoglycemia after Roux-en-Y gastric bypass

BackgroundRoux-en-Y gastric bypass (RYGB) results in pronounced weight loss in morbidly obese patients but may also cause adverse effects like early dumping and hypoglycemia. Prevalence data on these complications and their potential predictors are sparse. ObjectiveTo assess the prevalence and possible predictors of early dumping and hypoglycemia in a population-based cohort of RYGB patients. SettingUniversity Hospital, Denmark. DesignA questionnaire survey was performed in the Central Denmark Region including RYGB-operated patients (years 2006–2011, n = 2238) and a nonoperated comparison cohort (n = 89). The Dumping Rating Scale and the Edinburgh Hypoglycemia Scoring System, together with demographic and clinical characteristics, were used, and possible predictors were examined by logistic regression. ResultsThe response rate was 64% (1429/2238). In total, 9.4% (134/1429) and 6.6% (95/1429) experienced moderate or severe symptoms of early dumping and hypoglycemia, respectively, which were significantly higher than in the comparison cohort. Because 3.4% (95% CI: 2.5–4.4) of the RYGB group experienced both early dumping and hypoglycemia, the total prevalence of 1 or both conditions was 12.6 (95% CI 10.9–14.4). Possible predictors for both conditions were body mass index (BMI)<25 kg/m2 (odds ratio [OR] 1.70 (95% CI: 0.98–2.95) and OR 1.60 (95% CI: .83–3.06), respectively) compared with patients with BMI 25–30 kg/m2. Younger age seemed to increase the risk of both conditions (<35 yr: OR 1.75 (95% CI: 1.11–2.75) and OR .59 (95% CI: .93–2.72), respectively) compared with patients>45 years. ConclusionSymptoms of early dumping and hypoglycemia were rather common with a prevalence of 1 or both conditions of 12.6% after RYGB. Predictors included younger age and a lower BMI.

Non-pharmacological therapy and neuroimaging in Alzheimer's disease

Non-pharmacological therapy is of current interest in new AD treatments development. We present the results of transcatheter method for AD treatment based on angiogenesis stimulation, revascularization and restoration of brain microvasculature using transluminal impact by low-energy laser radiation. Examination plan: CDR determination, MMSE, CT or MRI with temporal lobes atrophy degree calculation and AD stages determination by «Tomography Dementia Rating scale» (TDR), cerebral scintigraphy (SG), rheoencephalography (REG), cerebral MUGA. Basic cerebral changes at AD were identified: temporal lobes atrophy, along with capillary blood flow reduction in the temporal and fronto-parietal regions, with simultaneous multiple arteriovenous shunts in the same regions, and early venous capillary blood dumping. To stimulate brain angiogenesis and transcatheter revascularization, low-energy laser systems were used. 46 patients were treated, aged 34-79 (average 65), under examination because of AD, of which: Group (TDR-0) - 4 (8.7%) - pre-clinical AD stage without any particular cognitive impairment and dementia manifestations, having 2 or more direct relatives with AD; Group (TDR-1) - 15 (32,6%) - AD history up to 2 years, mild dementia, mild cognitive impairment and mild manifestations of the disease (corresponds to CDR-1); Group (TDR-2) - 20 (43,5%) - AD history up to 6 years, moderate dementia, persistent cognitive impairment and more severe manifestations of the disease (corresponds to CDR-2); Group (TDR-3) - 7 (15.2%) - AD history of 7-12 years, severe dementia, severe cognitive impairment and late stages of the disease (corresponds to CDR-3). Good angiographic outcome manifested in persistent angiogenesis, capillary blood flow restoration and arteriovenous shunts reduction, was obtained in all cases, which in turn led to amyloid beta metabolism normalization in the cerebral tissue. In the long-term (2-6 years), all 46 patients showed 8-15% temporal lobes tissue mass growth accompanied by dementia level decrease and cognitive functions improvement. All patients were transferred to earlier TDR groups or withdrawn from the scale. According to cerebral MUGA, all 8 (17.39%) re-examined patients had further angiogenesis progression. The proposed non-pharmacological treatment promotes amyloid beta elimination, suspends AD progression or even cause its regression, furthering cerebral tissue regeneration. Patient A., 56 years old. Left internal carotid artery angiogram, side view, arterial phase. Prior to the transcatheter treatment; Hypovascular area in the fronto-parietal and temporal region. Same patient A., 56 years old. Left internal carotid artery angiogram, side view, arterial phase. After the transcatheter treatment; Restoration of capillary blood supply in the fronto-parietal and temporal regions.

Dumping syndrome following gastric surgery

Dumping syndrome is the term used to describe a common set of symptoms following gastric surgery, and is characterised by postprandial discomfort which can entail nutritional problems. The condition was well known when surgery was the usual treatment for peptic ulcer disease. The increasing number of operations for morbid obesity means that the condition is once again of relevance, and health personnel will encounter these patients in different contexts. This article discusses the prevalence, symptomatology and treatment of dumping syndrome. This review article is based on a selection of articles identified in PubMed and assessed as having particular relevance for elucidating this issue, as well as on the authors' own clinical experience. Early dumping syndrome generally occurs within 15 minutes of ingesting a meal and is attributable to the rapid transit of food into the small intestine. Nausea, abdominal pain, diarrhoea, a sensation of heat, dizziness, reduced blood pressure and palpitations are typical symptoms. Lethargy and sleepiness after meals are common. Late dumping syndrome occurs later and may be attributed to hypoglycaemia with tremors, cold sweats, difficulty in concentrating, and loss of consciousness. Dumping-related symptoms occur in between 20 and 50% of patients following gastric surgery. Early dumping syndrome is more frequent than late dumping syndrome. It is estimated that 10-20% of patients have pronounced symptoms and 1-5% have severe symptoms. The diagnosis is usually made on the basis of typical symptoms. Most patients experience alleviation of the symptoms over time and with changes in diet and eating habits. Further patient evaluation and drug or surgical intervention may be relevant for some individuals. Dumping-related symptoms are common after gastric surgery. The extent of obesity surgery in particular means that health personnel should be familiar with this condition.

Meta-analysis of pylorus-preserving gastrectomy for middle-third early gastric cancer.

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. 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. 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). 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.

PATHOLOGY OF CEREBROVASCULAR ANGIOARCHITECTONICS AND MICROCIRCULATION IN ETIOLOGY AND PATHOGENESIS OF ALZHEIMER'S DISEASE

There have recently appeared many reports dedicated to cerebral hemodynamics disorders during AD progression. However, certain aspects of cerebral blood flow and microcirculation during AD are not fully understood. This research focuses on the identification of cerebral angioarchitectonics features and the study of microcirculatory disorders arising during AD progression, and on the determination of their importance in AD etiology and pathogenesis. 164 patients participated in the research: Test Group - 81 patients with different AD stages; Control Group - 83 patients with etiologically different neurodegenerative brain lesions accompanied by manifestations of dementia and cognitive impairment of varying severity but without AD. All patients underwent: assessment of cognitive function (MMSE), severity of dementia (CDR) and AD stages (TDR), laboratory examination, computed tomography (CT), magnetic resonance imaging (MRI), brain scintigraphy (SG), rheoencephalography (REG) and cerebral multi-gated angiography (MUGA). All Test Group patients, with both pre-clinical and clinical AD stages, had disorders of cerebral microcirculation manifested in dyscirculatory angiopathy of Alzheimer's type (DAAT), namely: capillary bed reduction in the hippocampus and frontal-parietal regions; multiple arteriovenous shunts in the basin of arterial branches supplying the hippocampus and fronto-parietal brain regions; early venous dumping of arterial blood through these shunts with simultaneous filling of arteries and veins; abnormally enhanced lateral venous trunks receiving blood from the arterio-venous shunts; anomalous venous congestion at the border of frontal and parietal lobe caused by the increased blood inflow from the arterial-venous shunts; increased looping of distal intracranial arterial branches. Control group patients had no combinations of such changes in angioarchitectonics and microcirculation. The primary basis for these changes is cerebral microcirculation disorders manifested in capillary bed reduction and decreased blood flow to cerebral tissues. The process is accompanied by natural arteriovenous shunts leading to arterial blood dumping to the venous bed followed by temporal and fronto-parietal lateral veins enlargement and subsequent blood congestion. Finally, long-term chronic hypoperfusion of these areas follows causing specific cerebral tissue hypoxia and ischemia. These changes may then affect amyloid beta metabolism and facilitate its accumulation in brain tissue stimulating AD progression. Patient Sh., 68 years old. Angiogram of the right internal carotid artery; TDR-3; lateral projection, arterial phase; Absence of atherosclerotic changes of intracranial vessels. 1: Development of hypovascular region; 2: Multiple arteriovenous shunts in fronto-parietal and temporal regions Patient O., 72 years old. Angiogram of the left internal carotid artery; TDR-2; lateral projection, capillary phase; Absence of atherosclerotic changes of intracranial vessels. 1: Development of hypovascular area; 2: Multiple arteriovenous shunts in fronto-parietal and temporal regions; 3: The development of early venous discharge in the temporal and fronto- parietal region. Simul-taneous filling of arteries and veins. Patient P., 75 years old. Angiogram of the right internal carotid artery; TDR-3; lateral projection, venous phase; 4: The development of pathologically enlarged veins that receive blood from arteriovenous shunts in the temporal and fronto-parietal region; 5: Blood congestion on the border of the fronto-parietal region. Patient P., 75 years old. Angiogram of the right internal carotid artery; TDR-3; lateral projection, early arterial phase; Absence of atherosclerotic changes of intracranial vessels. 1: Development of hypovascular area; 6: Multiple loop formation.

Abstracts of 2014 IFSO-EC Congress

Introduction: Worldwide gastric bypass is still the most frequent performed weight loss operations for morbid obesity and it's effectively is proven. Although dumping has been widely recognized as complication after RYGB, almost no data are available on the prevalence and the consequences of this syndrome. The aim of this study therefore was to investigate the impact of early and late dumping on quality of life after primary gastric bypass. Methods: From January 2008 till December 2011 all patients who underwent bariatric surgery at the Centre for Obesity at the Medical Centre Leeuwarden were included in a prospective database. All patients were invited for a questionnaire survey. This survey contains questionnaire about demographic characteristics, quality of life questionnaires (RAND-36, HADS, MFI and HFS-II) and a dumping severity score. Results: The questionnaire was filled in by 360 patients (58,4%). Self reported prevalence of early and late dumping was 21,3 and 20.2%, respectively. Patients with early and late dumping had significantly poorer scores on the HADS and RAND-36 compared with patients without dumping. No differences were seen in the MFI-20 scores. The negative effects observed for health related quality of life, fear and depression were of similar magnitude in patients with early and late dumping. In the Hypoglycemia Fear Scale (HFS-II) all 12 subscales were significantly different between patients with or without late dumping (all P<0.001). Conclusion: Early and late dumping has a symptom prevalence of 20% and affects health related quality of life, fear and depression significantly. Furthermore, diabetes mellitus seems to have no relation with dumping symptoms.

Changes in dementia diagnostic category and diagnostic confidence following dopamine transporter SPECT imaging (DaTscanTM - Ioflupane 123I) in people with an uncertain diagnosis of dementia with Lewy bodies (possible DLB)

AD stages or a predisposition to the disease:Preclinical AD stage TDR0: 9 (11.11%) direct relatives of patients with primary involutive changes in the brain; MMSE 26-28 points; Early AD stage TDR-1: 24 (29.63%) patients with mild dementia, mild cognitive impairment, had previously been diagnosed with AD; MMSE 20-25 points; Middle AD stage TDR-2: 31 (38.27%)patients with moderate dementia, sufficiently resistant cognitive impairment, had previously been diagnosed with AD; MMSE 12-19 points;Late AD stage TDR-3: 17 (20.99%) patients with a fairly severe dementia, gross cognitive impairment, had previously been diagnosed with AD; MMSE 7-11 points. Control Group: 59 patients with the most common brain lesions accompanied by neurodegenerative changes and development of dementia and cognitive impairment, but not suffering from AD. Results: Patients with different AD stages revealed the following changes in angioarchitectonics and microcirculation:Absence of marked atherosclerotic lesions of intracranial vessels;Degeneration of the capillary bed in the temporal and fronto-parietal regions;Development of multiple arteriovenous shunts in the same regions;Early venous dumping;Abnormal extension of venous trunks that receive blood from arteriovenous shunts in the temporal and fronto-parietal regions;Stagnation of venous blood on the border of the frontal and parietal regions;Increased looping of intracranial arteries. Control Group patients had no combination of such changes. Conclusions: These vascular changes are specific for AD and form the vascular factor of the disease which plays an important role in AD etiology and pathogenesis. Patients suffering from other diseases associated with neurodegenerative changes in the brain do not have similar lesions.

Gut hormones, early dumping and resting energy expenditure in patients with good and poor weight loss response after Roux-en-Y gastric bypass

To identify factors contributing to the variation in weight loss after Roux-en-Y gastric bypass (RYGB). Cross-sectional study of patients with good (excess body mass index lost (EBL) >60%) and poor weight loss response (EBL <50%) >12 months after RYGB and a lean control group matched for age and gender. Sixteen patients with good weight loss response, 17 patients with poor weight loss response, and eight control subjects were included in the study. Participants underwent dual energy X-ray absorptiometry scan, indirect calorimetry and a 9 h multiple-meal test with measurements of glucose, insulin, total bile acids (TBA), glucagon-like peptide (GLP)-1, peptide YY3-36 (PYY), cholecystokinin (CCK), ghrelin, neurotensin and pancreatic polypeptide (PP) as well as assessment of early dumping and appetite. Suppression of hunger was more pronounced in the good than the poor responders in response to the multiple-meal test (P=0.006). In addition, the good responders had a larger release of GLP-1 (P=0.009) and a greater suppression of ghrelin (P=0.037) during the test, whereas the postprandial secretion of CCK was highest in the poor responders (P=0.005). PYY, neurotensin, PP and TBA release did not differ between the RYGB-operated groups. Compared with control subjects, patients had exaggerated release of GLP-1 (P<0.001), PYY (P=0.008), CCK (P=0.010) and neurotensin (P<0.001). Early dumping was comparable in the good and poor responders, but more pronounced than in controlled subjects. Differences in resting energy expenditure between the three groups were entirely explained by differences in body composition. Favorable meal-induced changes in hunger and gut hormone release in patients with good compared with poor weight loss response support the role of gut hormones in the weight loss after RYGB.

Disorders of cerebrovascular angioarchitectonics and microcirculation in the etiology and pathogenesis of Alzheimer’s disease

There have recently appeared many reports dedicated to cerebral hemodynamics disorders in AD. However, certain specific aspects of cerebral blood flow and microcirculation during this disease are not fully understood. This research focuses on the identification of particular features of cerebral angioarchitectonics and microcirculation at preclinical and clinical AD stages and on the determination of their importance in AD etiology and pathogenesis. 164 patients participated in the research: Test Group—81 patients with different AD stages; Control Group— 83 patients with etiologically different neurodegenerative brain lesions with manifestations of dementia and cognitive impairment but without AD. All patients underwent: assessment of cognitive function (MMSE), severity of dementia (CDR) and AD stages (TDR), laboratory examination, computed tomography (CT), magnetic resonance imaging (MRI), brain scintigraphy (SG), rheoencephalography (REG) and cerebral multigated angiography (MUGA). All Test Group patients, irrespective of their AD stage, had abnormalities of the cerebral microcirculation manifested in dyscirculatory angiopathy of Alzheimer’s type (DAAT), namely: reduction of the capillary bed in the hippocampus and frontal-parietal regions; development of multiple arteriovenous shunts in the same regions; early venous dumping of arterial blood through these shunts with simultaneous filling of arteries and veins; development of abnormally enlarged lateral venous trunks that receive blood from the arterio-venous shunts; anomalous venous congestion at the border of frontal and parietal region; increased loop formation of distal intracranial arterial branches. Control group patients did not have combinations of such changes. These abnormalities are specific for AD and can affect amyloid beta metabolism contributing to its accumulation in the brain tissue and thereby stimulating AD progression.

Octreotide improves early dumping syndrome potentially through incretins: a case report

Dumping syndrome, or rapid gastric emptying, is a frequent complication after gastric surgery. In this case, the patient was a 47-year-old woman who 10 years previously had undergone distal gastrectomy with Billroth I reconstruction for early-stage gastric cancer. She presented with symptoms of weakness, headache, palpitation, sweating, dizziness and significant fatigue between one and two hours after a meal. Because a 75 g oral glucose tolerance test (75 g-OGTT) induced both acute postprandial tachycardia (within 1 hour) and postprandial hypoglycemia, we diagnosed this patient with early and late dumping syndrome. Dietary measures and acarbose improved symptoms of late dumping syndrome but did not prevent the symptoms of early dumping syndrome such as postprandial tachycardia, weakness, headache, palpitation, and dizziness. We therefore used the somatostatin analogue octreotide, which has been reported as an effective therapy for early dumping syndrome. Octreotide prevented the symptoms of early dumping syndrome, especially postprandial tachycardia, but caused postprandial hyperglycemia. Glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) were completely suppressed during the 75 g-OGTT following subcutaneous injection of octreotide. No change was observed in vasoactive intestinal polypeptide (VIP), which is the gastrointestinal peptide hormone generally responsible for early dumping syndrome, suggesting possible contribution of incretins in early dumping syndrome of this patient.

Dumping Symptoms and Incidence of Hypoglycaemia After Provocation Test at 6 and 12 Months After Laparoscopic Sleeve Gastrectomy

A previous study has demonstrated that symptoms suggestive of dumping syndrome appear after a provocation test early after laparoscopic sleeve gastrectomy (LSG) in 45% of patients, and these are mainly related to early dumping. The aim of this study is to evaluate the evolution of dumping symptoms during the first postoperative year. Twenty-five non-diabetic morbidly obese patients (6 male, 19 female) were evaluated with an oral glucose tolerance test (OGTT) preoperatively, at 6weeks and at 6months postoperatively. In addition, 12 of them repeated the OGTT at 12months after LSG. Sigstad score was used to separate dumpers from non-dumpers and Arts' questionnaire to differentiate between early and late dumping. Insulin and glucose levels were also measured. Sigstad score remained significantly elevated at 6 and 12months postoperatively compared to preoperative values. Symptoms suggestive of dumping syndrome were recorded in 40% of patients at 6months and in 33% at 12months postoperatively. Arts' questionnaire demonstrated that early dumping score remained higher compared to baseline at 6 and 12months postoperatively. Late dumping scores increased gradually during the time and that difference was statistically significant at 12months after LSG. Hypoglycaemia occurred at 33% of patients both at 6 and 12months postoperatively. Symptoms suggestive of dumping syndrome after provocation still exist at 6 and 12months in a significant proportion of patients after LSG and include both early and late dumping. These findings are consistent with the high incidence of hypoglycaemia after OGTT at 6 and 12months after LSG.

Certain new aspects of etiology and pathogenesis of Alzheimer’s disease

The research focuses on the possibility of early detection of AD-specific vascular and atrophic brain changes in families which have a tendency to inherit the disease. The research includedthree families with AD inheritance. All patientsunderwent: cognitive function assessment(MMSE),determination of dementia severity(CDR) and AD stages (TDR), computed tomography (CT), magnetic resonance imaging (MRI), scintigraphy of the brain (SG), rheoencephalography (REG), and cerebral multigated angiography (MUGA). All patients with different AD stages, as well as their descendants, have specific atrophic changes in the temporal lobes of the brain. The degree of these changes increases as AD becomes more severe and ranges from 4% - 8% (TDR-0) to 33% - 62% (TDR-3) of the total mass of a healthy person’s temporal lobes. Simultaneously, thepatients examined have changes of microcirculation manifested by reduction of the capillarybed in the temporal and frontalparietal regions,the development of multiple arteriovenousshunts in the same areas, early venous dumping, anomalous expansion of venoustrunks that receive blood from the arterialvenous shunts, venous stasis on the frontoparietal boundary. Similar changes are found among AD patients’ descendants aged 8 - 11, the only difference being in the degree of temporal lobes atrophy which is 4.7%. This proves that microcirculatory disorders are primary and atrophic changes of the temporal lobes are secondary in AD development. The data obtained indicate that the examination of AD patients’ relatives should begin well before the possible manifestations of the disease, even in childhood. It will allow to reveal the possibility of inheritance and the signs of the disease at the earliest possible stage and to begin its treatment in time.

Symptoms Suggestive of Dumping Syndrome After Provocation in Patients After Laparoscopic Sleeve Gastrectomy

Dumping syndrome is a well-known complication after upper gastrointestinal (GI) surgery. There are scarce data in the literature about the incidence of dumping after bariatric operations but, certainly no relation between this syndrome and laparoscopic sleeve gastrectomy (LSG) has been attempted. We conducted a prospective clinical study in order to evaluate the potential presence, incidence and severity of Dumping syndrome after LSG. Thirty one non-diabetic morbidly obese patients (eight male, 23 female) eligible for LSG were evaluated. Median age was 38 (22-58 years) and mean body mass index (BMI) was 45.55 (± 5.37). The diagnosis of dumping syndrome was based on clinical provocation of signs and symptoms using an oral glucose challenge before and 6 weeks after the operation. The Sigstad's dumping score was estimated in order to separate dumpers from non-dumpers, and the Arts questionnaire was completed to distinguish between early and late dumping. Moreover, blood glucose levels during the oral glucose challenge were measured. No patient had symptoms of dumping after provocation preoperatively, whereas after LSG 9 patients (29%) experienced definite dumping and other 5 patients (16%) symptoms suggestive of dumping syndrome. Arts' questionnaire demonstrated that dumping occurrence after LSG was associated with early symptoms. Late hypoglycaemia occurred in one patient. A significant proportion of patients after LSG experienced dumping syndrome upon provocation. It seems that LSG should no longer be considered as a pure restrictive procedure, and it might be an option for heavy sweeters by changing their food tolerance patterns.

Early Dumping Syndrome and Reflux Esophagitis Prevention with Pouch Reconstruction

Total gastrectomy causes numerous disorders, such as reflux esophagitis, dumping syndrome, malabsorption, and malnutrition. To minimize the consequences, different variants of reconstruction are performed. The aim of our study is the comparison of two reconstructive methods: the standard Roux-en-Y and a new modality of pouch interposition, preduodenal-pouch interposition. This study aims to investigate the advantage of bile reflux prevention and to reduce symptoms of dumping syndrome after 3- and 6-mo follow-up. A total of 60 patients were divided in two groups: (A) 30 patients with Roux-en-Y reconstruction, and (B) 30 patients with the preduodenal-pouch (PDP) type of reconstruction. Endoscopic examination and endoluminal jejunal limb pressure measurements were performed. Scintigraphic measurements of half-emptying time were performed to evaluate meal elimination in the context of reflux esophagitis and early dumping syndrome. The Japan Society of Gastrointestinal Surgery has provided guidelines with which to classify the symptoms of early dumping syndrome. Patients were followed up for periods of 3 and 6 mo after the surgery. Our study groups did not differ with regard to the level of reflux esophagitis (P = 0.688). Average values of pressure at 10 and 15 cm below the esophago-jejunal junction were significantly lower in the PDP group (P < 0.001). Elimination of the test meal between two groups was not significant (P = 0.222). Evaluation of early dumping syndrome symptoms revealed a significant reduction among PDP patients after 3 and 6 mo. Our study showed significant superiority of the new pouch reconstruction over the standard Roux-en-Y approach in the treatment of early dumping syndrome.

Large-Scale Investigation into Dumping Syndrome after Gastrectomy for Gastric Cancer

The aim of this study was to investigate early and late dumping syndromes in a large number of patients after gastrectomy for gastric cancer. Responses to questions on a visual analogue scale survey completed by 1,153 gastrectomy patients were analyzed for associations between clinical factors and occurrence of dumping syndrome. Types of gastrectomy included distal gastrectomy with Billroth I or with Roux-Y reconstruction, pylorus preserving gastrectomy, proximal gastrectomy, and total gastrectomy. Based on the visual analogue scale rating of symptomatic discomfort, patients were categorized into 1 of 2 groups: symptom-free or symptomatic. Incidences of early or late dumping syndrome in all patients were 67.6% and 38.4%, respectively. Patients in whom early dumping syndrome developed were significantly more likely to experience late dumping syndrome than those in whom it did not develop (p < 0.001). According to multivariate analyses, factors that decreased the risk for developing early dumping syndrome were reduced weight loss (p < 0.01), old age (p < 0.01), pylorus preserving gastrectomy (p < 0.01), distal gastrectomy with Roux-Y reconstruction (p < 0.01), and distal gastrectomy with Billroth I (p = 0.019). In addition, factors that decreased the risk of developing late dumping syndrome were reduced weight loss (p = 0.03), being male (p < 0.01), pylorus preserving gastrectomy (p < 0.01), and distal gastrectomy with Roux-Y reconstruction (p < 0.01). No other clinical factors (lymph node dissection, vagal nerve preservation, and postoperative period) showed a substantial association with the occurrence of dumping syndrome in multivariate analyses. Substantially more patients suffered from early dumping syndrome than late dumping syndrome after gastrectomy. Two clinical factors, surgical procedures and amount of body weight loss, associated significantly with the occurrence of both early and late dumping syndrome.

Gastric Emptying Function in Patients 5 Years After Pylorus‐Preserving Distal Gastrectomy With or Without Preserving Pyloric and Hepatic Branches of the Vagal Nerve for Early Gastric Cancer

To clarify the significance of preserving pyloric and hepatic branches of the vagal nerve (PHV) after pylorus preserving distal gastrectomy (PPG) for early gastric cancer, the author investigated the postgastrectomy syndrome and gastric emptying function at 5 years in PPG patients with or without preserving the PHV. A total of 18 subjects (mucosal cancers) who underwent PPG with D1 lymph node dissection and preserving the PHV; they comprised group A-12 men and 6 women aged 38-68 years (mean 58.9 years). They were interviewed to inquire about gastrointestinal symptom (appetite, weight loss, gastric fullness, reflux esophagitis, early dumping syndrome) and then were compared with 24 PPG patients (submucosal cancers) with D2 lymph node dissection without preserving the PHV (group B-16 men and 8 women aged 33 to 69 years, mean 60.1 years). Esophagogastric endoscopy, abdominal ultrasonography, and gastric emptying function tests (GET) were undertaken, the latter by both radioisotope (solid diet) and acetaminophen (liquid diet) methods. There were no differences in the postoperative gastrointestinal symptoms, endoscopic reflux esophagitis, or endoscopic mucosal edema and redness (gastropathy) between groups A and B. However, more cholecystolithiasis (gallbladder stones) was found in group A than in group B, with the difference being significant (P < 0.0391). The GET for solid diet and liquid diet were the almost same among groups A and B. There were no significant differences in the postoperative QOL and GET between PPG patients with preserving PHV and those without preserving PHV. Cholecystolithiasis was only found in patients without preserving PHV.

Pancreatoduodenal surgery in patients with multiple endocrine neoplasia type 1: Operative outcomes, long-term function, and quality of life

Pancreatoduodenal (PD) neoplasms represent the principal disease-specific lethality in multiple endocrine neoplasia type 1 (MEN1). Potential oncologic benefits of PD resection must be weighed against operative morbidities, compromised pancreatic function, and quality of life (QOL). Fifty MEN1 patients underwent PD resections during 1984-2004. Postoperative pancreatic function and QOL were assessed by EORTC QLQ-C30 and a disease-specific questionnaire (response rate, 78%). Twelve patients (24%) had asymptomatic disease detected by screening; 38 patients (76%) were symptomatic. All gross neoplasm was resected in 80% of patients. No patients died; 21 patients (42%) had complications. At 5 years postoperatively, 60% of patients were alive without disease, 24% of patients were with disease, 10% of patients died of PD neoplasms, 4% of patients died of other malignancies, and 2% of patients died of an unknown cause. Diabetes that requires insulin or oral hypoglycemics developed in 20% of patients. Frequent steatorrhea (>once/week) occurred in 25% of patients, early dumping occurred in 25% of patients, bloating occurred in 25% of patients, late dumping occurred in 7% of patients, hypoglycemia occurred in 7% of patients, and vomiting occurred in 4% of patients. Global QOL did not differ from that of the reference population (72.8 vs 75.3; P = .58). PD resections in MEN1 are associated with perioperative risks and altered pancreatic function. The moderate compromise in patient-perceived QOL suggests that most patients accept and adapt to these trade-offs for the potential of prolonged survival.

Symptom evaluation of long-term postoperative outcomes after pylorus-preserving gastrectomy for early gastric cancer

Since the early 1990s, pylorus-preserving gastrectomy (PPG) has been used in the treatment of patients with early gastric cancer in order to reduce postprandial symptoms. To date, there have been few reports of long-term symptom evaluation following this procedure. The aim of this study was to evaluate long-term postoperative outcomes after PPG. Three hundred and ninety-seven patients with early gastric cancer were enrolled in this study: 194 patients who underwent PPG and 203 who underwent distal gastrectomy with Billroth-I reconstruction (DGBI). We compared the symptoms for the two groups in a questionnaire on postoperative functional outcomes, endoscopy findings and the appearance of gallstones after surgery. The incidence of symptoms suggesting early dumping syndrome was significantly lower in the PPG group compared with the DGBI group (P < 0.05). The incidences of disturbed bowel habit and frequent flatus were significantly lower in the PPG than in the DGBI group. The average relative body weight (actual BW/ BW immediately before the surgery) was significantly better in the PPG than in the DGBI group (P < 0.001). The long-term results show that PPG has clear advantages over DGBI in terms of postoperative symptoms and functional outcomes. These results imply that PPG should be the recommended procedure for early gastric cancers located in the middle third of the stomach.

Outcome of Segmental Gastrectomy versus Distal Gastrectomy for Early Gastric Cancer

Because of the frequent occurrence of postgastrectomy disturbances after distal gastrectomy (DG), segmental gastrectomy (SG) has recently been applied to early gastric cancer (EGC). Outcomes of SG and DG in patients with EGC were compared to clarify the usefulness of SG as a treatment for EGC. This retrospective study involved 61 patients with EGC: 28 patients who underwent DG before March 1996 and 33 patients who underwent SG after April 1996 during the period April 1991 through March 2002. Patient and tumor characteristics, operative results, and postoperative outcomes were compared between the two groups. The postoperative/preoperative body weight ratio was higher in the SG group than in the DG group. Early dumping syndrome and reflux gastritis occurred less frequently after SG than after DG. The incidence of postoperative complications was similar in the two groups. All patients remained alive without recurrence during a mean follow-up period of 54.7 months in the SG group and 99.9 months in the DG group. In comparison to DG, SG is associated with improved postoperative quality of life with no decrease in operative curability of EGC. Thus, SG is a feasible treatment for EGC.

Somatostatin analogue SMS 201-995 (octreotide) as a possible solution to the dumping syndrome after gastrectomy or vagotomy.

The dumping syndrome, which may follow partial gastrectomy or truncal vagotomy and drainage, may be refractory to treatment. The aim of this study was to determine the effect of the somatostatin analogue, SMS 201-995 (octreotide), on dumping provoked by hypertonic glucose. Ten patients with symptoms and signs of dumping were studied. After a dumping provocation test with placebo, all patients developed severe symptoms: seven patients had early dumping, two had both early and late dumping and one had late dumping alone. With either 50 or 100 micrograms SMS 201-995, the symptoms of early dumping were much reduced in all patients, and those of late dumping were completely abolished. The packed cell volume, pulse and systolic blood pressure changes of early dumping were significantly reduced by SMS 201-995 and the fall in blood glucose in patients with late dumping was abolished. SMS 201-995 may be a useful treatment for early and late dumping.