title: Effects of gastrogastric fistula repair on weight loss and gut hormone levels.
abstract: BACKGROUND
  Weight regain after gastric bypass (GBP) can be associated with a gastrogastric fistula (GGF), in which a channel forms between the gastric pouch and gastric remnant, allowing nutrients to pass through the "old route" rather than bypassing the duodenum. To further understand the mechanisms by which GGF may lead to weight regain, we investigated gut hormone levels in GBP patients with a GGF, before and after repair.
  
  
  METHODS
  Seven post-GBP subjects diagnosed with GGF were studied before and 4 months after GGF repair. Another cohort of 22 GBP control subjects without GGF complication were studied before and 1 year post-GBP. All subjects underwent a 50-g oral glucose tolerance test and blood was collected from 0-120 min for glucose, insulin, ghrelin, PYY3-36, GIP, and GLP-1 levels.
  
  
  RESULTS
  Four months after GGF repair subjects lost 6.0 ± 3.9 kg and had significantly increased postprandial PYY3-36 levels. After GGF repair, fasting and postprandial ghrelin levels decreased and were strongly correlated with weight loss. The insulin response to glucose also tended to be increased after GGF repair, however no concomitant increase in GLP-1 was observed. Compared to the post-GBP group, GLP-1 and PYY3-36 levels were significantly lower before GGF repair; however, after GGF repair, PYY3-36 levels were no longer lower than the post-GBP group.
  
  
  CONCLUSIONS
  These data utilize the GGF model to highlight the possible role of duodenal shunting as a mechanism of sustained weight loss after GBP, and lend support to the potential link between blunted satiety peptide release and weight regain.
authors.affiliation: New York Obesity Nutrition Research Center, Department of Medicine, St Luke's Roosevelt Hospital Center, 1111 Amsterdam Avenue, New York, NY 10025, USA.
authors.forename: Ciaran S
authors.initials: CS
authors.lastname: O'Brien
authors.forename: Gary
authors.initials: G
authors.lastname: Wang
authors.forename: James
authors.initials: J
authors.lastname: McGinty
authors.forename: Keesandra K
authors.initials: KK
authors.lastname: Agénor
authors.forename: Roxanne
authors.initials: R
authors.lastname: Dutia
authors.forename: Antonia
authors.initials: A
authors.lastname: Colarusso
authors.forename: Koji
authors.initials: K
authors.lastname: Park
authors.forename: Ninan
authors.initials: N
authors.lastname: Koshy
authors.forename: Blandine
authors.initials: B
authors.lastname: Laferrère
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D005260:Female; D015390:Gastric Bypass; D005747:Gastric Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D005768:Gastrointestinal Hormones / Q000097:blood*; D005773:Gastroscopy / Q000379:methods; D054439:Ghrelin / Q000097:blood; D052216:Glucagon-Like Peptide 1 / Q000097:blood; D006801:Humans; D007328:Insulin / Q000097:blood; D010535:Laparoscopy / Q000379:methods; D008297:Male; D009767:Obesity, Morbid / Q000097:blood* / Q000150:complications / Q000601:surgery; D010446:Peptide Fragments / Q000097:blood; D019894:Peptide YY / Q000097:blood; D011183:Postoperative Complications / Q000097:blood* / Q000209:etiology / Q000601:surgery; D011184:Postoperative Period; D057234:Preoperative Period; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D015431:Weight Loss
chemical_list: D001786:Blood Glucose; D005768:Gastrointestinal Hormones; D054439:Ghrelin; D007328:Insulin; D010446:Peptide Fragments; D019894:Peptide YY; C061785:peptide YY (3-36); D052216:Glucagon-Like Peptide 1
references.citation: J Clin Endocrinol Metab. 2006 May;91(5):1735-40
references.pmid: 16478824
references.citation: Diabetes. 2011 Sep;60(9):2308-14
references.pmid: 21868791
references.citation: Physiol Behav. 2006 Jun 30;88(3):277-82
references.pmid: 16782138
references.citation: Surg Obes Relat Dis. 2005 Sep-Oct;1(5):467-74
references.pmid: 16925272
references.citation: Int J Obes. 1986;10(2):117-21
references.pmid: 3721699
references.citation: Gastroenterology. 2011 Sep;141(3):950-8
references.pmid: 21699789
references.citation: N Engl J Med. 2012 Apr 26;366(17):1567-76
references.pmid: 22449319
references.citation: Surg Obes Relat Dis. 2012 Jul-Aug;8(4):371-4
references.pmid: 22480751
references.citation: Gastroenterology. 2010 Jun;138(7):2437-46, 2446.e1
references.pmid: 20226188
references.citation: Obes Surg. 2012 May;22(5):740-8
references.pmid: 22354457
references.citation: Obes Surg. 2012 Aug;22(8):1263-7
references.pmid: 22527599
references.citation: Obes Surg. 2007 Mar;17(3):304-10
references.pmid: 17546836
references.citation: Ann Surg. 2004 Jan;239(1):1-11
references.pmid: 14685093
references.citation: Ann Surg. 2008 Jun;247(6):968-75
references.pmid: 18520224
references.citation: Ann Surg. 2007 Nov;246(5):780-5
references.pmid: 17968169
references.citation: Am J Physiol Regul Integr Comp Physiol. 2012 Nov 15;303(10):R985-93
references.pmid: 22972837
references.citation: Diabetes Care. 2012 Jan;35(1):42-6
references.pmid: 22124715
references.citation: Am J Physiol Endocrinol Metab. 2005 Feb;288(2):E447-53
references.pmid: 15454396
references.citation: Diabetes Care. 2007 Jul;30(7):1709-16
references.pmid: 17416796
references.citation: Am J Surg. 2007 Aug;194(2):221-4
references.pmid: 17618808
references.citation: Obes Surg. 2005 Oct;15(9):1258-64
references.pmid: 16259883
references.citation: Br J Surg. 2006 Feb;93(2):210-5
references.pmid: 16392104
references.citation: Am J Surg. 2010 Mar;199(3):382-5; discussion 385-6
references.pmid: 20226915
references.citation: Am J Physiol Endocrinol Metab. 2007 Aug;293(2):E604-9
references.pmid: 17566112
references.citation: Obes Surg. 2010 Aug;20(8):1090-5
references.pmid: 20440578
references.citation: Surg Obes Relat Dis. 2008 Jan-Feb;4(1):55-9
references.pmid: 18201671
references.citation: Diabetes. 2005 Nov;54(11):3198-204
references.pmid: 16249445
references.citation: Obesity (Silver Spring). 2010 Jun;18(6):1085-91
references.pmid: 20057364
references.citation: J Gastrointest Surg. 2012 Jun;16(6):1116-22
references.pmid: 22402955
references.citation: Ann Surg. 1995 Apr;221(4):387-91
references.pmid: 7726674
references.citation: J Clin Endocrinol Metab. 2010 Apr;95(4):1851-5
references.pmid: 20133462
references.citation: Am J Med. 2009 Mar;122(3):248-256.e5
references.pmid: 19272486
references.citation: J Clin Endocrinol Metab. 2003 Apr;88(4):1594-602
references.pmid: 12679444
references.citation: Am J Physiol Gastrointest Liver Physiol. 2011 May;300(5):G795-802
references.pmid: 21372167
references.citation: Ann Surg. 2012 Jun;255(6):1080-5
references.pmid: 22534421
references.citation: J Clin Endocrinol Metab. 2001 Oct;86(10):4753-8
references.pmid: 11600536
references.citation: Ann Surg. 2006 Nov;244(5):734-40
references.pmid: 17060766
references.citation: Surg Obes Relat Dis. 2012 Jul-Aug;8(4):408-15
references.pmid: 22055390
references.citation: Obes Surg. 2006 Dec;16(12):1594-601
references.pmid: 17217635
references.citation: Obes Surg. 2012 Nov;22(11):1761-70
references.pmid: 22911148
references.citation: JSLS. 2006 Jul-Sep;10(3):326-31
references.pmid: 17212889
references.citation: Am J Physiol Endocrinol Metab. 2007 Jan;292(1):E238-45
references.pmid: 16940471
references.citation: Ann Surg. 2009 Jun;249(6):948-53
references.pmid: 19474685
references.citation: Br J Surg. 1982 Nov;69(11):655-7
references.pmid: 7127049
references.citation: Obes Surg. 2012 Jul;22(7):1077-83
references.pmid: 22419108
references.citation: J Gastrointest Surg. 2009 Oct;13(10):1762-72
references.pmid: 19488823
references.citation: Clin Chim Acta. 2011 Jun 11;412(13-14):1191-4
references.pmid: 21414305