Ri M, Nunobe S, Ida S, Ishizuka N, Atsumi S, Makuuchi R, Kumagai K, Ohashi M, Sano T. Preliminary prospective study of real-time post-gastrectomy glycemic fluctuations during dumping symptoms using continuous glucose monitoring. World J Gastroenterol 2021; 27(23): 3386-3395 [PMID: 34163119 DOI: 10.3748/wjg.v27.i23.3386]
Corresponding Author of This Article
Souya Nunobe, MD, PhD, Director, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan. souya.nunobe@jfcr.or.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Motonari Ri, Souya Nunobe, Satoshi Ida, Shinichiro Atsumi, Rie Makuuchi, Koshi Kumagai, Manabu Ohashi, Takeshi Sano, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
Naoki Ishizuka, Clinical Trial Planning and Management, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
Author contributions: Ri M, Nunobe S, Ida S, Kumagai K, Ohashi M and Sano T designed this study; Ri M, Ida S and Atsumi S acquired data; Ri M prepared the final database; Ri M, Nunobe S and Ida S undertook the statistical analysis; Ishizuka N supervised the statistical analysis; Ri M wrote the draft paper; all authors critically reviewed and gave final approval of the version to be published.
Institutional review board statement: This study was approved by the institutional review board in the Cancer Institute Hospital (No. 2017-1110).
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors have no financial relationships with a commercial entity producing health-care related products and/or services relevant to this article.
Data sharing statement: Technical appendix, statistical code and dataset available from the corresponding author at souya.nunobe@jfcr.or.jp. Participants gave informed consent for data sharing. No additional data are available.
STROBE statement: The authors have read the STROBE statement, and the manuscript was prepared and revised according to the STROBE statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Souya Nunobe, MD, PhD, Director, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan. souya.nunobe@jfcr.or.jp
Received: December 25, 2020 Peer-review started: December 25, 2020 First decision: February 28, 2021 Revised: April 14, 2021 Accepted: May 22, 2021 Article in press: May 22, 2021 Published online: June 21, 2021 Processing time: 175 Days and 1.2 Hours
Abstract
BACKGROUND
Although 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.
AIM
To investigate relationships between glucose fluctuations and the occurrence of dumping symptoms in patients undergoing gastrectomy for gastric cancer.
METHODS
Patients 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.
RESULTS
Thirty 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.
CONCLUSION
Postprandial glycemic changes suggest dumping symptoms after standard gastrectomy for gastric cancer. Furthermore, glycemic profiles during dumping may differ depending on reconstruction methods after gastrectomy.
Core Tip: Glucose variability at dumping onset was investigated using continuous glucose monitoring and subject diaries after standard gastrectomy for gastric cancer. Postprandial glycemic changes suggest both early and late dumping symptoms. Glycemic profiles during dumping may differ depending on reconstruction methods after gastrectomy, considering the similar glucose fluctuation curves with both early and late dumping after distal gastrectomy with Billroth I reconstruction and rapidly decreasing glucose profiles with late dumping after distal and total gastrectomy, both with Roux-en-Y reconstruction.
