Gastrostomy tube placement in gastric remnant at gastric bypass: a rat model for selective gut stimulation.
BACKGROUND
Roux-en-Y gastric bypass (RYGB) surgery achieves high remission rates of type 2 diabetes mellitus in obese diabetic patients. It has been hypothesized that the changes in bowel nutrient exposure after RYGB results in altered release of gut hormones and improved glucose homeostasis. Our objective was to assess the feasibility of, and report on, our technique and initial experience with selective gut stimulation in a gastric bypass rat model at an academic medical center in the United States.


METHODS
We performed RYGB with simultaneous placement of a gastrostomy tube in the excluded gastric remnant in 8 obese Sprague-Dawley rats. A second group of 8 obese Sprague-Dawley rats underwent gastrostomy tube placement without gastric bypass and served as the controls. Each rat was tested for oral glucose tolerance preoperatively. On postoperative days 14 and 28, glucose tolerance was re-evaluated using the oral and gastrostomy tube routes.


RESULTS
The gastrostomy tubes were successfully inserted in all the rats with no tube-related complications. The area under the curve after oral glucose gavage decreased significantly after gastric bypass (P = .01 at 14 d and P = .003 at 28 d). The gastric remnant glucose gavage after RYGB essentially reversed the effects of surgery on glucose metabolism. The areas under the curve showed no significant differences in the control group between the preoperative and postoperative oral or tube results.


CONCLUSIONS
Placing a gastrostomy tube into the gastric remnant at RYGB in a rat model is technically feasible. Our initial findings support the role of duodenal exclusion in improving glucose metabolism after RYGB.
Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH 44195, USA. eldars@ccf.org
Shai
S
Eldar
Helen M
HM
Heneghan
Olivia
O
Dan
John P
JP
Kirwan
Philip R
PR
Schauer
Stacy A
SA
Brethauer
D000818:Animals; D019540:Area Under Curve; D001786:Blood Glucose / Q000378:metabolism; D001835:Body Weight / Q000502:physiology; D004195:Disease Models, Animal; D005240:Feasibility Studies; D015390:Gastric Bypass / Q000379:methods*; D018530:Gastric Stump / Q000601:surgery*; D005774:Gastrostomy / Q000379:methods*; D005951:Glucose Tolerance Test / Q000379:methods; D006706:Homeostasis / Q000502:physiology; D007441:Intubation, Gastrointestinal / Q000379:methods; D009765:Obesity / Q000601:surgery*; D011184:Postoperative Period; D051381:Rats; D017207:Rats, Sprague-Dawley
D001786:Blood Glucose