经口胃出口缩小术治疗 Roux-en-Y 胃旁路术后餐后低血糖
Transoral gastric outlet reduction for post-prandial hypoglycemia after Roux-en-Y gastric bypass.
机构信息
Division of Digestive and Liver Diseases, University of Texas Southwestern, Dallas, TX, USA.
University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
出版信息
Surg Endosc. 2023 Nov;37(11):8285-8290. doi: 10.1007/s00464-023-10389-z. Epub 2023 Sep 6.
BACKGROUND
Post-prandial hypoglycemia is an uncommon but disabling late complication of Roux-en-Y gastric bypass (RYGB). Most patients can be treated with dietary interventions and medications; however, some patients develop refractory hypoglycemia that may lead to multiple daily episodes and seizures. While RYGB reversal surgery is an effective treatment, complication rates are high, and patients inevitably experience weight regain. Transoral gastric outlet reduction (TORe) is a minimally invasive treatment that is effective for early and late dumping syndrome. However, prior studies have not distinguished the effectiveness of TORe specifically for patients with post-prandial hypoglycemia. This study aims to describe a single institution's experience of TORe for treating post-prandial hypoglycemia.
METHODS
This is a case series of patients with prior RYGB complicated by post-prandial hypoglycemia who underwent TORe from February 2020 to September 2021. Pre-procedural characteristics and post-procedural outcomes were obtained. Outcomes assessed included post-prandial hypoglycemia episodes, dumping syndrome symptoms, and weight change.
RESULTS
A total of 11 patients underwent TORe from 2020 to 2021 for post-prandial hypoglycemia. Three (27%) patients had a history of seizures due to hypoglycemia. All had been advised on dietary changes, and ten patients (91%) were on medications for dumping. All patients reported a reduction in post-prandial hypoglycemic events as well as the majority of dumping syndrome symptoms during an average follow-up time of 409 ± 125 days. Ten patients (91%) had experienced weight regain from their post-RYGB nadir weight. For these patients, the average total body weight loss 12 months post-TORe was 12.4 ± 12%. There were no complications requiring hospitalization. One patient experienced post-TORe nausea and vomiting requiring dilation of the gastrojejunal anastomosis with resolution in symptoms.
CONCLUSION
TORe is a safe and effective treatment for post-prandial hypoglycemia and weight regain after RYGB in patients with symptoms refractory to medications and dietary changes.
背景
餐后低血糖是 Roux-en-Y 胃旁路术（RYGB）后一种罕见但致残的迟发性并发症。大多数患者可以通过饮食干预和药物治疗；然而，一些患者出现难治性低血糖，可能导致每日多次发作和癫痫发作。虽然 RYGB 逆转手术是一种有效的治疗方法，但并发症发生率很高，患者不可避免地会出现体重反弹。经口胃出口缩小术（TORe）是一种有效的治疗早期和晚期倾倒综合征的微创治疗方法。然而，之前的研究并未区分 TORe 对餐后低血糖患者的具体疗效。本研究旨在描述一家机构使用 TORe 治疗餐后低血糖的经验。
方法
这是一项回顾性病例系列研究，纳入了 2020 年 2 月至 2021 年 9 月期间因 RYGB 术后并发餐后低血糖而行 TORe 的患者。获取了术前特征和术后结局。评估的结局包括餐后低血糖发作、倾倒综合征症状和体重变化。
结果
2020 年至 2021 年期间，共有 11 例患者因餐后低血糖而行 TORe。其中 3 例（27%）患者因低血糖曾出现癫痫发作。所有患者均接受过饮食改变的建议，10 例患者（91%）正在服用治疗倾倒综合征的药物。所有患者报告餐后低血糖发作减少，且大多数倾倒综合征症状在平均 409±125 天的随访期间得到缓解。10 例患者（91%）在 RYGB 术后的最低体重后出现体重反弹。对于这些患者，TORe 术后 12 个月的平均全身减重为 12.4±12%。无需要住院治疗的并发症。1 例患者在 TORe 术后出现恶心呕吐，需行胃肠吻合口扩张治疗，症状缓解。
结论
TORe 是一种安全有效的治疗方法，可治疗 RYGB 术后药物和饮食改变无效的餐后低血糖和体重反弹。
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