1. Hyperinsulinemic Hypoglycemia after Bariatric Surgery: Diagnosis and Management Experience from a Spanish Multicenter Registry
- Author
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María José Morales, Nuria Vilarrasa, José Ignacio Botella, Irene Bretón, María Jesús Díaz-Fernández, Albert Goday, Silvia Pellitero, Andrea Ciudin, Assumpta Caixàs, Albert Lecube, Miguel A. Rubio, Alfonso Calañas, and Pedro Pablo García-Luna
- Subjects
Male ,Health (social science) ,genetic structures ,Revisional surgery ,Octreotide ,medicine.disease_cause ,0302 clinical medicine ,Nesiodioblastosis ,Obesity Surgery ,Obesitat--Cirurgia ,Registries ,Hipoglucèmia ,lcsh:RC620-627 ,Incidence ,Stomach ,Middle Aged ,lcsh:Nutritional diseases. Deficiency diseases ,Jejunum ,Cirurgia de l'obesitat ,Original Article ,Female ,030211 gastroenterology & hepatology ,lcsh:Nutrition. Foods and food supply ,Postprandial Hypoglycemia ,Adult ,medicine.medical_specialty ,Nesidioblastosis ,lcsh:TX341-641 ,030209 endocrinology & metabolism ,macromolecular substances ,Hypoglycemia ,behavioral disciplines and activities ,03 medical and health sciences ,Stomach surgery ,Pancreatectomy ,Neuroglycopenic hypoglycemia ,Hyperinsulinism ,Physiology (medical) ,medicine ,Humans ,Hyperinsulinemic hypoglycemia ,Retrospective Studies ,Bariatric surgery ,business.industry ,nutritional and metabolic diseases ,Retrospective cohort study ,Glucose Tolerance Test ,medicine.disease ,Surgery ,Spain ,Postprandial hypoglycemia ,business ,Complication - Abstract
Background: Severe postprandial hypoglycemia after bariatric surgery is a rare but invalidating complication. Our aim was to describe the different tests performed for its diagnosis and their outcomes as well as the response to the prescribed pharmacological and surgical treatments. Methods: Multicenter, retrospective systematic review of cases with recurrent severe postprandial hypoglycemia. Results: Over 11 years of follow-up, 22 patients were identified. The test most used to provoke hypoglycemia was the oral glucose load test followed by the mixed meal test which was the least standardized test. With pharmacological treatment, 3 patients were symptom-free (with octreotide) and in 12 patients hypoglycemic episodes were attenuated. Seven patients had persistent hypoglycemic episodes and underwent surgery. Partial pancreatectomy was performed in 3 patients who had positive selective arterial calcium stimulation, and nesidioblastosis was confirmed in 2 patients. Reconversion to normal anatomy was performed in 3 patients, and 1 patient underwent a resection of the ‘candy cane' roux limb, with resolution of hypoglycemia in all cases. Conclusions: There is high heterogeneity in the evaluation and treatment options for postoperative hypoglycemia. In patients that do not respond to pharmacological treatment, reconstruction of gastrojejunal continuity may be the safest and most successful procedure.