Gastric emptying and postprandial PYY response after biliopancreatic diversion with duodenal switch.
BACKGROUND
Super-obesity (BMI > 50) is increasing rapidly. We use the biliopancreatic diversion with duodenal switch (BPD-DS) as one option in this patient category. The aim of the present study was to investigate the emptying of the gastric tube, PYY levels and dumping symptoms after BPD-DS.


METHODS
Emptying of the gastric tube was investigated with scintigraphy after an overnight fast. Twenty patients (median age 43 years, BMI 31.1 kg/m²) having undergone BPD-DS in median 3.5 years previously were included in the scintigraphic study. A technetium-labelled omelette was ingested and scintigraphic evaluation of gastric emptying was undertaken. Ten of the patients also underwent PYY measurements after a standardised meal and were compared to nine non-operated age-matched normal weight controls, both in the fasting state and after the test meal. Frequency of dumping symptoms was evaluated in all patients.


RESULTS
The half-emptying time was 28 ± 16 min. Lag phase was present in 30% of the patients. PYY levels were significantly higher in BPD-DS patients as compared to controls both in the fasting state (p < 0.001) and after the test meal (p < 0.001). Dumping symptoms were scarce and occurred in 17 of the 20 patients only few times yearly or less.


CONCLUSIONS
Although the pylorus is preserved in BPD-DS, the stomach emptying is faster than in non-operated subjects. PYY levels are elevated in the fasting state after BPD-DS and a marked response to a test meal is seen, likely due to the rapid stimulation of intraluminal nutrients in the distal ileum. In spite of this, dumping symptoms are uncommon.
Hedberg
Jakob
J
Department of Surgical Sciences, Uppsala University, 75185 Uppsala, Sweden. jakob.hedberg@surgsci.uu.se
Hedenström
Hans
H
Karlsson
F Anders
FA
Edén-Engström
Britt
B
Sundbom
Magnus
M
D000328:Adult; D015904:Biliopancreatic Diversion / Q000379:methods*; D004377:Dumping Syndrome / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D005746:Gastric Emptying / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology; D019894:Peptide YY / Q000097:blood*; D011184:Postoperative Period; D019518:Postprandial Period / Q000502:physiology; D011708:Pylorus / Q000503:physiopathology; D011877:Radionuclide Imaging; D013270:Stomach / Q000000981:diagnostic imaging
D019894:Peptide YY