Does Reconstruction Type After Gastric Resection Matters for Type 2 Diabetes Improvement?

Costa, Mariana; Lima, Artur Trovão; Morais, Tiago; Almeida, Rui; Nora, Mário; Guimarães, Marta; Monteiro, Mariana P.

doi:10.1007/s11605-019-04255-4

Cited by 4 publications

(3 citation statements)

References 44 publications

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“…Choi et al [19] compared the effects of R-Y and B-I reconstruction after DG on diabetes control in patients with early gastric cancer who had type 2 diabetes, and showed that R-Y reconstruction specifically ameliorated type 2 diabetes. Costa et al [20] also found that R-Y reconstruction significantly reduced BMI and ameliorated diabetes in obese patients with type 2 diabetes. Thus, R-Y reconstruction seems to be more effective at lowering blood glucose than other methods of reconstruction.…”

Section: Discussionmentioning

confidence: 91%

Utility of continuous glucose monitoring following gastrectomy

et al. 2020

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Background Glucose fluctuation after gastrectomy represented by dumping syndrome is a well-known post-gastrectomy syndrome that negatively impacts patient quality of life. However, the current methods of post-gastrectomy glucose monitoring do not comprehensively capture the postoperative blood glucose fluctuations that characterize this. Methods We used a continuous glucose monitoring (CGM) system to document the glycemic profiles of patients undergoing gastrectomy and compared these between patients undergoing distal gastrectomy (DG) and total gastrectomy (TG). To evaluate post-gastrectomy syndromes, including dumping syndrome, we used the Post-gastrectomy Syndrome Assessment Scale 37-item questionnaire. The glycemic profiles were also compared using this tool. Results We studied 57 patients who had undergone DG and 13 who had undergone TG between September 2017 and September 2019. Our results revealed larger diurnal glycemic variability and longer periods of nocturnal hypoglycemia after gastrectomy. The dumping score was worse in the TG than in the DG group (TG 2.4 ± 1.4 vs. DG 1.3 ± 1.2, P = 0.0061). Importantly, 30 of 57 DG patients (52.6%) and 5 of 13 TG patients (38.5%) experienced postprandial hypoglycemia following hyperglycemia without hypoglycemic symptoms. There was no correlation between the dumping symptom score and glycemic variability (ρ = 0.0545, P = 0.6662). Conclusions CGM demonstrated diurnal glycemic variability and nocturnal hypoglycemia in patients undergoing gastrectomy. Because some hypoglycemic patients did not develop symptoms and glycemic variability was not necessarily associated with dumping symptom, dumping syndrome must only partially explain the postoperative glucose fluctuations.

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Section: Discussionmentioning

confidence: 91%

Utility of continuous glucose monitoring following gastrectomy

et al. 2020

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“…In patients with digestive tract reconstruction after radical gastrectomy, changes in the structure of the digestive tract, the abundance and proportion of intestinal microbiota, and its influence on fatty acid metabolism and further intestinal homeostasis is a complex biological process affected by multiple factors. 12 , 48 It is still unclear whether SCFAs, as important metabolites of intestinal microbiota, regulate immune cells in this process to reduce excessive immune responses caused by changes in colonic symbionts and maintain homeostasis in the internal environment. As a product of the anaerobic fermentation of dietary fiber, SCFAs are important substances that regulate intestinal immune responses.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have focused on the role of digestive tract reconstruction in weight reduction and improvements in type 2 diabetes in obese patients with high BMIs. 11 , 12 However, the preoperative basic nutritional status is poor in some patients with advanced GC. Few studies have focused on the nutritional status of patients undergoing digestive tract reconstruction after radical gastrectomy, and the mechanism underlying the postoperative recovery stage remains to be elucidated.…”

Section: Introductionmentioning

confidence: 99%

Roux-en-Y reconstruction alleviates radical gastrectomy-induced colitis via down-regulation of the butyrate/NLRP3 signaling pathway

Yao¹,

Sun²,

Gu³

et al. 2022

eBioMedicine

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Assessing the Incidence of Postoperative Diabetes in Gastric Cancer Patients: A Comparative Study of Roux-en-Y Gastrectomy and Other Surgical Reconstruction Techniques

Onishi

2024

Preprint

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Study objective: Sleeve gastrectomy is effective in morbid obesity, and it improves glucose homeostasis. In gastric cancer patients with type 2 diabetes mellitus, gastrectomy, including total gastrectomy (TG), is beneficial for glycaemic control. However, the effects of gastrectomy and different reconstructive techniques on the incidence of postoperative diabetes in gastric cancer patients are unclear. This study investigated the development of new-onset diabetes in these patients, focusing on different reconstruction methods. Design: A comparative study Setting: Electrical medical records Patients: This study included 715 patients without diabetes who underwent TG at Tokyo Metropolitan Bokutoh Hospital between August 2005 and March 2019. Interventions: Patients underwent reconstruction by Roux-en-Y (RY) or other surgical techniques (OT), with diabetes onset determined by HbA1c levels or medical records. Measurements: Analyses included two-sample t-tests, chi-squared tests, and the Kaplan-Meier method with log-rank tests to compare the onset curves between the two groups. Main Results: Stratified data analysis compared the RY and OT reconstruction methods. Log-rank test results (P=0.0217) indicated a statistically significant difference in the incidence of new-onset diabetes between RY and OT groups in gastric cancer patients. Conclusion: This first-of-its-kind study provides insight into how different methods of gastric reconstruction affect postoperative diabetes. The results suggest significant differences in new-onset diabetes mellitus after surgery based on the reconstruction method. This research highlights the need for careful surgical planning to consider potential postoperative diabetes, particularly in patients with a family history of diabetes mellitus. Future studies should investigate the role of gut microbiota and other reconstructive techniques, such as laparoscopic jejunal interposition, in developing postoperative diabetes.

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Does Reconstruction Type After Gastric Resection Matters for Type 2 Diabetes Improvement?

Cited by 4 publications

References 44 publications

Utility of continuous glucose monitoring following gastrectomy

Utility of continuous glucose monitoring following gastrectomy

Roux-en-Y reconstruction alleviates radical gastrectomy-induced colitis via down-regulation of the butyrate/NLRP3 signaling pathway

Assessing the Incidence of Postoperative Diabetes in Gastric Cancer Patients: A Comparative Study of Roux-en-Y Gastrectomy and Other Surgical Reconstruction Techniques

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