Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 21, 2021; 27(23): 3386-3395
Published online Jun 21, 2021. doi: 10.3748/wjg.v27.i23.3386
Preliminary prospective study of real-time post-gastrectomy glycemic fluctuations during dumping symptoms using continuous glucose monitoring
Motonari Ri, Souya Nunobe, Satoshi Ida, Naoki Ishizuka, Shinichiro Atsumi, Rie Makuuchi, Koshi Kumagai, Manabu Ohashi, Takeshi Sano
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
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

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 reconstruction (TG-RY) were prospectively enrolled in this study. Based on the glucose concentration values measured every 15 min by CGM and the details of the dumping symptoms (early dumping within 1 h postprandially, late dumping within 1 h to 3 h postprandially) described in diaries, patients with dumping-associated glycemic changes (dumping profiles) were compared to those without symptoms (control profiles). This is the first examination of real-time glucose variability during the onset of dumping symptoms using CGM.

Research results

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.

Research conclusions

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.

Research perspectives

We will conduct a prospective interventional study with the aim of developing new treatments ameliorating dumping symptoms associated with GC surgery.