Effects of Gastrogastric Fistula Repair on Weight Loss and Gut Hormone Levels

• Published in: Obesity surgery Vol. 23; no. 8; pp. 1294 - 1301
• Main Authors: O’Brien, Ciaran S., Wang, Gary, McGinty, James, Agénor, Keesandra K., Dutia, Roxanne, Colarusso, Antonia, Park, Koji, Koshy, Ninan, Laferrère, Blandine
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01-08-2013; Springer Nature B.V
• Subjects: Adult; Blood Glucose - metabolism; Body Mass Index; Endoscopy, Gastrointestinal - methods; Female; Gastric Bypass; Gastric Fistula - diagnosis; Gastric Fistula - etiology; Gastric Fistula - surgery; Gastrointestinal Hormones - blood; Gastrointestinal surgery; Gastroscopy - methods; Ghrelin - blood; Glucagon-Like Peptide 1 - blood; Hormones; Humans; Insulin - blood; Laparoscopy - methods; Male; Medicine; Medicine & Public Health; Obesity; Obesity, Morbid - blood; Obesity, Morbid - complications; Obesity, Morbid - surgery; Original Contributions; Peptide Fragments - blood; Peptide YY - blood; Postoperative Complications - blood; Postoperative Complications - etiology; Postoperative Complications - surgery; Postoperative Period; Preoperative Period; Surgery; Suture Techniques; Time Factors; Treatment Outcome; United States - epidemiology; Weight control; Weight Loss; United States; PYY; GLP-1; Ghrelin; Gastrogastric fistula; Gastric bypass; Weight loss
• ISSN: 0960-8923; 1708-0428
• DOI: 10.1007/s11695-013-0917-z

Background
Weight regain after gastric bypass (GBP) can be associated with a gastrogastric fistula (GGF), in which a channel forms between the gastric pouch and gastric remnant, allowing nutrients to pass through the “old route” rather than bypassing the duodenum. To further understand the mechanisms by which GGF may lead to weight regain, we investigated gut hormone levels in GBP patients with a GGF, before and after repair.
Materials and Methods
Seven post-GBP subjects diagnosed with GGF were studied before and 4 months after GGF repair. Another cohort of 22 GBP control subjects without GGF complication were studied before and 1 year post-GBP. All subjects underwent a 50-g oral glucose tolerance test and blood was collected from 0–120 min for glucose, insulin, ghrelin, PYY
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, GIP, and GLP-1 levels.
Results
Four months after GGF repair subjects lost 6.0 ± 3.9 kg and had significantly increased postprandial PYY
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levels. After GGF repair, fasting and postprandial ghrelin levels decreased and were strongly correlated with weight loss. The insulin response to glucose also tended to be increased after GGF repair, however no concomitant increase in GLP-1 was observed. Compared to the post-GBP group, GLP-1 and PYY
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levels were significantly lower before GGF repair; however, after GGF repair, PYY
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levels were no longer lower than the post-GBP group.
Conclusions
These data utilize the GGF model to highlight the possible role of duodenal shunting as a mechanism of sustained weight loss after GBP, and lend support to the potential link between blunted satiety peptide release and weight regain.