Published online Jun 21, 2021. doi: 10.3748/wjg.v27.i23.3386
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
Dumping symptoms constitute the most common post-gastrectomy syndrome adversely affecting quality of life. However, the causes of dumping symptoms, including blood glucose changes, remain poorly understood due to limitations in examining dumping symptoms as they occur.
The continuous glucose monitoring (CGM) system, which continuously measures interstitial glucose levels to reflect blood glucose levels, was developed for the management of diabetes. CGM also has the potential to provide long awaited essential information about the glucose profiles of patients suffering from dumping symptoms after gastrectomy.
We designed a prospective pilot study to investigate relationships between glucose fluctuations and the occurrence of dumping symptoms in patients undergoing gastrectomy for gastric cancer (GC). Our results may contribute to devising future treatments for dumping syndrome.
During the period from March 2018 to January 2020, GC patients who underwent distal gastrectomy with Billroth I reconstruction (DG-BI), distal gastrectomy with Roux-en-Y reconstruction (DG-RY) or total gastrectomy with Roux-en-Y recon
Thirty patients were enrolled (10 DG-BI, 10 DG-RY, 10 TG-RY). The early dumping profiles of DG-BI (47 profiles) showed a sharp and immediate rise after a meal, with significant increases up to 60 min postprandially as compared with the control group (47 profiles) (P < 0.05). The curves of late dumping profiles in DG-BI were similar to those of early dumping profiles, with generally lower glucose 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 the drop being steeper in TG-RY than in DG-RY.
Postprandial rapid glycemic changes appear to be involved in the onset of early and late dumping symptoms after standard gastrectomy for GC. In addition, the glycemic profiles associated with dumping symptoms may differ depending on the reconstruction methods employed after gastrectomy, considering the similar glucose fluctuation curves with both early and late dumping after DG-BI and rapidly decreasing glucose profiles with late dumping after DG-RY and TG-RY.
We will conduct a prospective interventional study with the aim of developing new treatments ameliorating dumping symptoms associated with GC surgery.