Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
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Postprandial Asymptomatic Glycemic Fluctuations after Gastrectomy for Gastric Cancer Using Continuous Glucose Monitoring Device

  • Ri, Motonari (Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research) ;
  • Nunobe, Souya (Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research) ;
  • Ida, Satoshi (Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research) ;
  • Ishizuka, Naoki (Department of Clinical Trial Planning and Management, Cancer Institute Hospital, Japanese Foundation for Cancer Research) ;
  • Atsumi, Shinichiro (Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research) ;
  • Hayami, Masaru (Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research) ;
  • Makuuchi, Rie (Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research) ;
  • Kumagai, Koshi (Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research) ;
  • Ohashi, Manabu (Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research) ;
  • Sano, Takeshi (Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research)
  • Received : 2021.08.16
  • Accepted : 2021.09.26
  • Published : 2021.12.31
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Abstract

Purpose: Although dumping symptoms are thought to involve postprandial glycemic changes, postprandial glycemic variability without dumping symptoms remains poorly understood due to the lack of a method that allows the easy and continuous measurement of blood glucose levels. Materials and Methods: Patients having undergone distal gastrectomy with Billroth-I (DG-BI) or Roux-en-Y reconstruction (DG-RY), total gastrectomy with RY (TG-RY) and pylorus preserving gastrectomy (PPG) for gastric cancer 3 months to 3 years prior, diagnosed as pathological stage I or II, were prospectively enrolled from March 2018 to January 2020. The interstitial tissue glycemic levels were measured every 15 min, up to 14 days by continuous glucose monitoring. Moreover, using a diary recording the diet and symptoms, asymptomatic glucose profiles without sugar supplementation within 3 h postprandially were compared among the four procedures. Results: A total of 40 patients were enrolled, 10 patients for each of the four procedures. There were 47 glucose profiles with DG-BI, 46 profiles with DG-RY, 38 profiles with TG-RY, and 46 profiles with PPG. PPG showed the slowest increase with a subsequent gradual decrease in glucose fluctuations, without hyperglycemia or hypoglycemia, among the four procedures. In contrast, TG-RY and DG-RY showed spike-like glycemic variability, sharp rises during meals, and rapid drops. The glucose profiles of DG-BI were milder than those of RY. Conclusions: The asymptomatic glycemic changes after meals differ among the types of surgical procedures for gastric cancer. Given the mild glycemic fluctuations in PPG and the glucose spikes in TG-RY and DG-RY, pylorus preservation and physiological reconstruction without changes in food pathways may optimize postprandial glucose profiles after gastrectomy.

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References

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