Post−Gastric Bypass Hyperinsulinism With Nesidioblastosis: Subtotal or Total Pancreatectomy May Be Needed to Prevent Recurrent Hypoglycemia

Clancy, Thomas E.; Moore, Francis D.; Zinner, Michael J.

doi:10.1016/j.gassur.2006.04.008

Cited by 133Bariatric Surgery and OutcomesPancreatic function and diabetesNeuroendocrine Tumor Research Advances

Post−Gastric Bypass Hyperinsulinism With Nesidioblastosis: Subtotal or Total Pancreatectomy May Be Needed to Prevent Recurrent Hypoglycemia

Clancy, Thomas E., Moore, Francis D., Zinner, Michael J.·2006·Journal of Gastrointestinal Surgery

DOI 10.1016/j.gassur.2006.04.008

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Abstract

Symptomatic hyperinsulinemic hypoglycemia and pancreatic nesidioblastosis have recently been described in a small series of patients after gastric bypass surgery for morbid obesity. In the limited published reports of patients with this condition, hyperinsulinism and nesidioblastosis have been managed with distal or subtotal pancreatectomy, with the extent of resection guided by calcium angiography. However, nesidioblastosis may involve the pancreas diffusely, and limited pancreatic resections may predispose patients to further hypoglycemic episodes. We have treated two patients with refractory hyperinsulinism and symptomatic hypoglycemia after successful gastric bypass surgery. One patient underwent an approximately 80% pancreatectomy with good results but subsequently experienced recurrent drop attacks and fainting from hyperinsulinism; a completion pancreatectomy via a pancreaticoduodenectomy was then required. A second patient had profound hyperinsulinemic hypoglycemia and was treated successfully with a subtotal (95%) pancreatectomy. Our experience, the third published report of post-gastric bypass nesidioblastosis, suggests that the risk of recurrent symptomatic hyperinsulinism after limited pancreatectomy is significant and relative euglycemia may be achieved with subtotal or total pancreatectomy.

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Pancreatic resection, the most commonly reported procedure, was performed in approximately 67% of patients.
“Pancreatic resection, the most commonly reported procedure, was performed in approximately 67% of patients (66,103,105,107,114,116-123).”
From Dumping syndrome after esophageal, gastric or bariatric surgery: Pathophysiology, diagnosis, and management (2017) · cites this paper as [116]
Some NIPHS patients are relieved from all symptoms upon left-sided partial/subtotal pancreatectomy, while others need total pancreatectomy for symptom control.
“While some patients are relieved from all symptoms upon left-sided partial/subtotal pancreatectomy, others need to undergo total pancreatectomy for symptom control [63-65].”
From An Uncommon Cause of Recurrent Presyncope, Dizziness, and Tachycardia: A Case Report of Diffuse, Adult-Onset Nesidioblastosis/Non-Insulinoma Pancreatogenous Hypoglycemia Syndrome (NIPHS) (2023) · cites this paper as [65]

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Authors: Clancy, T. E., Moore, F. D., & Zinner, M. J.
Affiliations: Brigham and Women's Hospital (US)
Corresponding author: Clancy, Thomas E.
ORCID: Clancy, Thomas E.
Zinner, Michael J.
Venue: Journal of Gastrointestinal Surgery
Publisher: Elsevier BV
Published: 2006-09
Volume: 10
Issue: 8
Pages: 1116-1119
ISSN: 1091-255X (ISSN-L)
DOI: 10.1016/j.gassur.2006.04.008
OpenAlex: W2099409010
Cited by: 133
References: 15
Citations by year: 2026: 1 · 2025: 3 · 2024: 5 · 2023: 5 · 2022: 3 · 2021: 3 · 2020: 7 · 2019: 4 · 2018: 3 · 2017: 2 · 2016: 10 · 2015: 9 · 2014: 10 · 2013: 6 · 2012: 9
FWCI: 7.75
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Journal of Gastrointestinal Surgery (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
Health Sciences › Medicine › Epidemiology › Neuroendocrine Tumor Research Advances
Keywords: recurrent hypoglycemia, subtotal pancreatectomy, total pancreatectomy, pancreaticoduodenectomy, morbid obesity, bariatric surgery complications, hyperinsulinemic-euglycemic clamp
MeSH terms: Adult, Female, Follow-Up Studies, Humans, Hyperinsulinism, Hypoglycemia, Middle Aged, Obesity, Morbid, Pancreatectomy, Postoperative Complications, Prognosis, Gastric Bypass, Nesidioblastosis, Secondary Prevention

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Post−Gastric Bypass Hyperinsulinism With Nesidioblastosis: Subtotal or Total Pancreatectomy May Be Needed to Prevent Recurrent Hypoglycemia

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