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Qvigstad E, Gulseth HL, Risstad H, et al. A novel technique of Roux-en-Y gastric bypass reversal for postprandial hyperinsulinemic hypoglycaemia: A case report. Int J Surg Case Rep. 2016;21:91-4doi: 10.1016/j.ijscr.2016.02.033.
Qvigstad, E., Gulseth, H. L., Risstad, H., le Roux, C. W., Berg, T. J., Mala, T., & Kristinsson, J. A. (2016). A novel technique of Roux-en-Y gastric bypass reversal for postprandial hyperinsulinemic hypoglycaemia: A case report. International journal of surgery case reports, 2191-4. https://doi.org/10.1016/j.ijscr.2016.02.033
Qvigstad, E, et al. "A novel technique of Roux-en-Y gastric bypass reversal for postprandial hyperinsulinemic hypoglycaemia: A case report." International journal of surgery case reports vol. 21 (2016): 91-4. doi: https://doi.org/10.1016/j.ijscr.2016.02.033
Qvigstad E, Gulseth HL, Risstad H, le Roux CW, Berg TJ, Mala T, Kristinsson JA. A novel technique of Roux-en-Y gastric bypass reversal for postprandial hyperinsulinemic hypoglycaemia: A case report. Int J Surg Case Rep. 2016;21:91-4. doi: 10.1016/j.ijscr.2016.02.033. Epub 2016 Feb 27. PMID: 26957187; PMCID: PMC4802335.
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Int J Surg Case Rep. 2016;21:91-4. doi: 10.1016/j.ijscr.2016.02.033. Epub 2016 Feb 27.

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

International journal of surgery case reports

E Qvigstad, H L Gulseth, H Risstad, C W le Roux, T J Berg, T Mala, J A Kristinsson

Affiliations

  1. Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Norway. Electronic address: [email protected].
  2. Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Norway.
  3. Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Norway; Faculty of Medicine, University of Oslo, Norway.
  4. Diabetes Complications Research Centre, Conway Institute, University College Dublin, Ireland.

PMID: 26957187 PMCID: PMC4802335 DOI: 10.1016/j.ijscr.2016.02.033

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.

Copyright © 2016. Published by Elsevier Ltd.

Keywords: Case report; GLP-1; Gastric bypass reversal; Hypoglycaemia; Obesity; Postprandial hyperinsulinemic hypoglycaemia; Roux-en-Y gastric bypass

References

  1. Diabetes Care. 2010 Feb;33(2):375-7 - PubMed
  2. Curr Opin Endocrinol Diabetes Obes. 2011 Apr;18(2):129-33 - PubMed
  3. Surg Obes Relat Dis. 2014 Nov-Dec;10(6):1220-5 - PubMed
  4. Obesity (Silver Spring). 2015 Apr;23(4):798-807 - PubMed
  5. Diabetologia. 2010 Nov;53(11):2307-11 - PubMed
  6. Surg Endosc. 2013 Dec;27(12):4640-8 - PubMed
  7. Diabetes Care. 2007 Jul;30(7):1868-70 - PubMed

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