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Obesity Surgery
Published in: Obesity Surgery 8/2013

01-08-2013 | Original Contributions

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

Authors: Ciaran S. O’Brien, Gary Wang, James McGinty, Keesandra K. Agénor, Roxanne Dutia, Antonia Colarusso, Koji Park, Ninan Koshy, Blandine Laferrère

Published in: Obesity Surgery | Issue 8/2013

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Abstract

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, PYY3-36, GIP, and GLP-1 levels.

Results

Four months after GGF repair subjects lost 6.0 ± 3.9 kg and had significantly increased postprandial PYY3-36 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 PYY3-36 levels were significantly lower before GGF repair; however, after GGF repair, PYY3-36 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.
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Metadata
Title
Effects of Gastrogastric Fistula Repair on Weight Loss and Gut Hormone Levels
Authors
Ciaran S. O’Brien
Gary Wang
James McGinty
Keesandra K. Agénor
Roxanne Dutia
Antonia Colarusso
Koji Park
Ninan Koshy
Blandine Laferrère
Publication date
01-08-2013
Publisher
Springer US
Published in
Obesity Surgery / Issue 8/2013
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-013-0917-z

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