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Hyperinsulinemic Hypoglycemia after Bariatric Surgery: Diagnosis and Management Experience from a Spanish Multicenter Registry
Open accessAbstract
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.
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“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 [66]
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“Administration of nifedipine in combination with verapamil to 10 patients who developed hyperinsulinemic hypoglycemia after bariatric surgery resulted in a partial response in five patients (50%) (66).”
From Dumping syndrome after esophageal, gastric or bariatric surgery: Pathophysiology, diagnosis, and management (2017) · cites this paper as [66]
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“Both short-acting and long-acting formulations of somatostatin analogues have demonstrated efficacy by slowing gastric emptying, improving hypoglycemia and reducing early and late dumping symptoms (Table 4) (15,66,(80)(81)(82)(83)(84)(85)(86)(87)(88)(89)(90)(91)(92)(93)(94)(95).”
From Dumping syndrome after esophageal, gastric or bariatric surgery: Pathophysiology, diagnosis, and management (2017) · cites this paper as [66]
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“A recent multicenter, retrospective, systematic case series reported that treatment of six patients who developed hyperinsulinemic hypoglycemia after bariatric surgery with diazoxide (168.7 ± 94 mg/day orally) resulted in a partial response (defined as a 50% reduction in the number and severity of hypoglycemic events) in three patients (50%) (66).”
From Dumping syndrome after esophageal, gastric or bariatric surgery: Pathophysiology, diagnosis, and management (2017) · cites this paper as [66]
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“Various surgical re-interventions have been used, including gastric tube placement, gastric bypass reversal with or without concomitant sleeve resection and gastric pouch restriction (Table 5) (66,103,105-123).”
From Dumping syndrome after esophageal, gastric or bariatric surgery: Pathophysiology, diagnosis, and management (2017) · cites this paper as [66]
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“As shown in Table 5, approximately 24% of patients who underwent surgical re-intervention because of refractory severe post-Roux-en-Y gastric bypass hypoglycemia received a gastric bypass reversal (66,103,106-113) and approximately 9% had gastric pouch restriction (66,114,115).”
From Dumping syndrome after esophageal, gastric or bariatric surgery: Pathophysiology, diagnosis, and management (2017) · cites this paper as [66]
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Spontaneous Hypoglycemia in a Non-diabetic Patient: A Diagnostic and Therapeutic Conundrum
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Post-bariatric Hypoglycemia Management: A Gulf Cooperation Council Consensus Statement
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Metadata
- Authors
- Vilarrasa, N., Goday, A., Rubio, M. A., Caixàs, A., Pellitero, S., Ciudin, A., Calañas, A., Botella, J. I., Bretón, I., Morales, M. J., Díaz-Fernández, M. J., García-Luna, P. P., & Lecube, A.
- Affiliations
- Bellvitge University Hospital (ES)
- Hospital del Mar Research Institute (ES)
- Hospital Del Mar (ES)
- Universitat Autònoma de Barcelona (ES)
- Venue
- Obesity Facts
- Publisher
- S. Karger AG
- Published
- 2016
- Volume
- 9
- Issue
- 1
- Pages
- 41-51
- ISSN
- 1662-4025 (ISSN-L)
- 1662-4033
- PMC
- PMC5644871
- OpenAlex
- W2276159333
- Cited by
- 197
- References
- 41
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 12 · 2023: 16 · 2022: 15 · 2021: 11 · 2020: 10 · 2019: 15 · 2018: 10 · 2017: 13 · 2016: 24
- FWCI
- 22.89
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Obesity Facts (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Dipòsit Digital de la Universitat de Barcelona (Universitat de Barcelona) (publishedVersion, cc-by-nc)
- Repositori digital de la UPF (Universitat Pompeu Fabra) (publishedVersion, cc-by-nc)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- RECERCAT (Consorci de Serveis Universitaris de Catalunya) (submittedVersion, cc-by-nc)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pancreatic function and diabetes
- Keywords
- hyperinsulinemic hypoglycemia, bariatric surgery complications, postprandial hypoglycemia, oral glucose tolerance test, mixed meal tolerance test, octreotide, partial pancreatectomy, nesidioblastosis, Roux-en-Y gastric bypass
- MeSH terms
- Adult, Female, Glucose Tolerance Test, Humans, Hyperinsulinism, Hypoglycemia, Jejunum, Male, Middle Aged, Pancreatectomy, Registries, Retrospective Studies, Spain, Stomach, Octreotide, Incidence, Nesidioblastosis, Bariatric Surgery
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