Symptoms Suggestive of Dumping Syndrome After Provocation in Patients After Laparoscopic Sleeve Gastrectomy
Abstract
Background Dumping syndrome is a well-known complication after upper gastrointestinal (GI) surgery. There are scarce data in the literature about the incidence of dumping after bariatric operations but, certainly no relation between this syndrome and laparoscopic sleeve gastrectomy (LSG) has been attempted. Methods We conducted a prospective clinical study in order to evaluate the potential presence, incidence and severity of Dumping syndrome after LSG. Thirty one non-diabetic morbidly obese patients (eight male, 23 female) eligible for LSG were evaluated. Median age was 38 (22-58 years) and mean body mass index (BMI) was 45.55 (± 5.37). The diagnosis of dumping syndrome was based on clinical provocation of signs and symptoms using an oral glucose challenge before and 6 weeks after the operation. The Sigstad's dumping score was estimated in order to separate dumpers from non-dumpers, and the Arts questionnaire was completed to distinguish between early and late dumping. Moreover, blood glucose levels during the oral glucose challenge were measured. Results No patient had symptoms of dumping after provocation preoperatively, whereas after LSG 9 patients (29%) experienced definite dumping and other 5 patients (16%) symptoms suggestive of dumping syndrome. Arts' questionnaire demonstrated that dumping occurrence after LSG was associated with early symptoms. Late hypoglycaemia occurred in one patient. Conclusion A significant proportion of patients after LSG experienced dumping s…
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Isolated late dumping (hypoglycemia as the only symptom) affects up to 25% of patients.
“Isolated late dumping (hypoglycemia as the only symptom) affects up to 25% of patients (6,13).”
From Dumping syndrome after esophageal, gastric or bariatric surgery: Pathophysiology, diagnosis, and management (2017) · cites this paper as [6]
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“Early dumping syndrome was the most common and found in approximately 40% of patients post RYGB and GS while late dumping was observed in 25% [7, 8].”
Migdanis, A., Koukoulis, G., Chougias, D., Migdanis, I., Armeni, E., Kanellakis, S., Manouras, A., Kapsoritakis, A. N., & Potamianos, S. (2023) · Cureus · doi:10.7759/cureus.48871 · Cited by 1 · see citing works
“The present study agrees with the findings of previous studies that after certain types of gastric surgery patients often develop postprandial symptoms related to DS [1,8,21,22,23].”
ResultSelf-citationReliability of the DSS-Swe Questionnaire
Jans, A., Rask, E., Ottosson, J., Magnuson, A., Szabó, É., & Stenberg, E. (2023) · Obesity Surgery · doi:10.1007/s11695-023-06841-7 · Cited by 2 · see citing works
“…Severity Scale (DSS), a questionnaire that was initially constructed to measure the treatment response of octreotide on dumping syndrome, was developed by Arts and colleagues [16] and has recently also been used to assess symptoms of dumping and hypoglycemia after bariatric surgery [17, 18].”
MethodLate dumping syndrome preceded by Coxsackievirus B4 infection and cholecystectomy
Weiss, J., Fewel, C., Akinrinade, O., & Harrington, J. (2023) · Journal of Surgical Case Reports · doi:10.1093/jscr/rjad205 · Cited by 2 · see citing works
“Dumping syndrome (DS) is a condition characterized by the accelerated passage of hyperosmolar contents from the stomach to the small bowel [1, 2].”
BackgroundBeyond diabetes remission a step further: Post bariatric surgery hypoglycemia
Lath, D., Cherian, K. E., Paul, T. V., & Kapoor, N. (2022) · World Journal of Diabetes · doi:10.4239/wjd.v13.i3.278 · Cited by 2 · see citing works
Whelehan, G., Herring, L. Y., Tziannou, A., Henson, J. J., Thackray, A. E., Bowrey, D. J., Abraham, J., Menon, V., Idris, I., Waller, H. L., et al. (2026) · Nutrients · doi:10.3390/nu18030469 · Cited by 1 · see citing works
“However, these changes also increase glycaemic variability, characterised by relatively sharp postprandial glucose and insulin excursions compared with individuals who have not undergone bariatric surgery, which in some cases can lead to postprandial hyperinsulinaemic hypoglycaemia (PHH) [4,5].”
Self-citationNutritional approach to dumping syndrome.
Scarpellini, E., & Siquini, W. (2025) · Best practice & research. Clinical gastroenterology · doi:10.1016/j.bpg.2025.102075 · Cited by 1 · see citing works
The Association of Gastroesophageal Reflux Disease and Dumping Postsleeve Gastrectomy
Jamal, M., Ali, S. A. B., Alsaber, A., Alhashemi, A., & Al-Sabah, S. (2021) · Bariatric Surgical Practice and Patient Care · doi:10.1089/bari.2021.0051 · Cited by 1 · see citing works
“19,20 In our study, a questionnaire was used without provocation tests; this allows for greater suitability for self-reporting, as demonstrated in other studies.”
Ernährungsmedizinische Betreuung prä- und postoperativ
Keuthage, W., & Schoppe, T. (2018) · Psychosoziale Aspekte der Adipositas-Chirurgie · doi:10.1007/978-3-662-57364-8_4 · Cited by 1 · see citing works
RetractedCapristo, E., Panunzi, S., Gaetano, A. D., Spuntarelli, V., Bellantone, R., Giustacchini, P., Birkenfeld, A. L., Amiel, S., Bornstein, S., Raffaelli, M., et al. (2018) · Journal of Clinical Endocrinology and Metabolism · doi:10.1210/jc.2018-01813 · Cited by 1
Managements and Follow-up of a Patient After Bariatric Surgery
Parsak, C. (2017) · Laparoscopic Endoscopic Surgical Science · doi:10.14744/less.2014.35229 · Cited by 1 · see citing works
Changes in eating behaviour and meal patterns following vertical sleeve gastrectomy
Abdeen, G. (2016) · doi:10.25560/34941 · Cited by 1
17 Sleeve Gastrectomy as a Revisional Procedure
Rosenthal, R. (2015) · Springer eBooks · doi:10.1007/978-1-4939-1637-5_17 · Cited by 1 · see citing works
Tase, A., Askari, A., Abed, M., Mussendeki, D., Al-Taan, O., Munasinghe, A., Rashid, F., Adil, T., Jambulingam, P., & Whitelaw, D. (2026) · Obesity Surgery · doi:10.1007/s11695-026-08657-7
“The underlying mechanism involves rapid gastric emptying of hyperosmolar food into the jejunum, triggering gastrointestinal and vasomotor symptoms [1–8].”
Use of transoral outlet reduction endoscopy (TORE) in the management of resistant dumping syndrome
Tase, A., Aly, M., Adil, M., Munasinghe, A., Rashid, F., Jambulingam, P., Whitelaw, D., Jain, V., Al-Taan, O., & Askari, A. (2026) · Surgical Endoscopy · doi:10.1007/s00464-026-12620-z
“Medications such as acarbose (alpha glucosidase inhibitors) have been tried with some effect in late dumping [7, 8].”
Ahmed, M. B., Doi, S. A., Habib, A. M., Badran, S., Alsherawi, A., Abdalhakam, I., Khoogaly, H., Hammouda, A., Abou-Samra, A., & Syed, A. (2026) · Metabolic Syndrome and Related Disorders · doi:10.1177/15578518251414565
“AHMED ET AL. syndrome since two prospective studies have reported that up to 40% of patients had symptoms suggestive of dumping syndrome 6 – 12 months after SG 37,38 and this is characterized by rapid nutrient transit and excessive insulin release.”
Qi, T.-F., Ma, H., Dai, X., Wang, L.-Y., He, J.-P., Liu, X., Wu, L., & Zhang, H.-B. (2025) · Journal of Surgical Case Reports · doi:10.1093/jscr/rjaf790
“Early DS specifically results from rapid nutrient delivery to the small bowel, triggering both vasomotor and gastrointestinal symptoms [3, 4].”
Postoperative Syndrome und Lebensqualität nach Eingriffen am Magen
Kist, M., Hummel, R., & Höppner, J. (2023) · Allgemein- und Viszeralchirurgie up2date · doi:10.1055/a-1186-6724
“Diagnostisch kommen ebenfalls die Endoskopie und schnittbildgebende Verfahren zum Einsatz.”
BackgroundInfluentialPark, 중. J. H. 박., Park, 용. Y. E. 박., & Kang, 미. M.-R. 강. (2020) · The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi · doi:10.4166/kjg.2020.75.6.347
Effect of laparoscopic sleeve gastrectomy on blood sugar and blood pressure
Al-Basri, R. J. (2019) · AL-Kindy College Medical Journal · doi:10.47723/kcmj.v15i1.88
“Although restrictive interventions like LSG would be expected to carry a low risk of dumping syndrome (DS), two prospective studies reported that up to 40% of patients had symptoms suggestive of dumping syndrome 6–12 months after sleeve gastrectomy (17-18) .”
BackgroundProcess Improving in Sleeve Gastrectomy
van Rutte, P. W. J. (2016) · Research Repository (Delft University of Technology) · doi:10.4233/uuid:91549107-7a2e-470c-8e08-cc3aa7200f42
Metabolic surgery – indications, procedures and outcome
Langer, F., & Prager, G. (2015) · doi:10.7707/hmj.432
Nutrition Management, Pre- and Postsurgery
Cummings, S. (2014) · CRC Press eBooks · doi:10.1201/b17281-4
Kushner, R., & Neff, L. M. (2013) · Lifestyle Medicine · doi:10.1177/1559827612467420
Leonetti, F., Capoccia, D., Coccia, F., & Conte, C. (2011) · L Endocrinologo · doi:10.1007/bf03344840
Stier, C. K., Ann-Cathrin, K., & Chiappetta, S. (2020) · Springer eBooks · doi:10.1007/978-3-030-28803-7_36
Nutritional Support After Bariatric Surgery
Martines, G., & Perrino, S. (2019) · Nutritional Support after Gastrointestinal Surgery · doi:10.1007/978-3-030-16554-3_9
Treatment of Obesity with Bariatric Surgery
Izaguirre, M., Frühbeck, G., & Catalán, V. (2018) · Elsevier eBooks · doi:10.1016/b978-0-12-801238-3.65164-4 · Cited by 2 · see citing works
Kushner, R. F., & Herrington, H. R. (2017) · Elsevier eBooks · doi:10.1016/b978-0-12-802928-2.00023-0 · Cited by 1 · see citing works
- Authors
- Tzovaras, G., Papamargaritis, D., Sioka, E., Zachari, E., Baloyiannis, I., Zacharoulis, D., & Koukoulis, G.
- Affiliations
- University Hospital of Larissa (GR)
- Corresponding author
- Tzovaras, George
- ORCID
- Venue
- Obesity Surgery
- Published
- 2011-06-07
- Volume
- 22
- Issue
- 1
- Pages
- 23-28
- ISSN
- 0960-8923 (ISSN-L)
- 1708-0428
- OpenAlex
- W1995529798
- Cited by
- 97
- References
- 23
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 4 · 2023: 10 · 2022: 3 · 2021: 4 · 2020: 8 · 2019: 9 · 2018: 9 · 2017: 5 · 2016: 8 · 2015: 9 · 2014: 7 · 2013: 4 · 2012: 9
- FWCI
- 6.87
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Obesity Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
- Health Sciences › Medicine › Surgery › Body Contouring and Surgery
- Keywords
- dumping syndrome, laparoscopic sleeve gastrectomy
- MeSH terms
- Adult, Dumping Syndrome, Female, Gastrectomy, Glucose Tolerance Test, Humans, Male, Middle Aged, Obesity, Morbid, Laparoscopy, Postoperative Complications, Prospective Studies, Surveys and Questionnaires, Weight Loss, Treatment Outcome, Young Adult
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