Validity of Continuous Glucose Monitoring for the Diagnosis of Dumping Syndrome After Metabolic Surgery, in Comparison to the Oral Glucose Tolerance Test.

PURPOSE: Dumping syndrome (DS) is a common complication of metabolic surgery, occurring in as many as 40% of bariatric patients. The reference diagnostic test is oral glucose tolerance testing (OGTT) which is often poorly tolerated and may induce false positive results. Continuous glucose monitoring (CGM) is better tolerated and can monitor patients for about 2 weeks in everyday life. This study aimed at testing the diagnostic capacity of CGM in patients with and without DS, as validated by OGTT. MATERIAL AND METHODS: This is a retrospective monocentric study including adults after bariatric surgery, who complained of DS-compatible symptoms and who had OGTT. CGM characteristics were compared in DS-positive (n = 37) and DS-negative patients (n = 14). RESULTS: None of the CGM parameters differed between the two groups: mean, variability, time in range, and time above or below range. OGTT induced different hematocrit and pulse rate responses (by DS definition) but no difference in blood glucose values. CONCLUSION: Despite being a better-tolerated test than OGTT, CGM should not be recommended for the diagnosis of DS. It may still be useful for monitoring glucose values in everyday life to help patients modify their diet, when DS is caused by carbohydrates with high glycemic index. The reference diagnostic test for dumping syndrome is poorly tolerated and artificial. CGM is useful in everyday life, and changes in glucose might be a signal of dumping syndrome. However, CGM is not a valid diagnostic test for dumping syndrome.

Efficacy of Nissen Sleeve Gastrectomy on Mid-term Barrett's Esophagus Regression.

INTRODUCTION: Sleeve gastrectomy is the most commonly performed bariatric operation globally. The main complication is GERD. In the medium term, it can increase the incidence of Barrett's esophagus (BE), which is a risk factor for esophageal adenocarcinoma. Following conventional sleeve gastrectomy, BE is noted in up to 16% of patients postoperatively. Recently, Nissen sleeve gastrectomy (NSG) has been shown to reduce the frequency of postoperative GERD compared to conventional sleeve gastrectomy. This study aims to evaluate the impact of NSG on the incidence and remission of BE in the long term. MATERIAL AND METHOD: This bicentric retrospective study included 692 patients who received NSG from September 2013 to July 2021. All patients underwent preoperative upper GI endoscopy and were then scheduled to receive upper GI endoscopy between 1 and 2 years and then between 3 and 5 years postoperatively. BE was systematically confirmed by biopsies. RESULTS: Seventy-four patients had endoscopic suspicion of BE, which was confirmed on 54/692 patients by histology. The BE lesions consisted of 18.5% intestinal metaplasia and 75.9% fundal metaplasia. Among these 54 patients, 38 underwent endoscopic investigation within 2 years postoperatively. The biopsies showed healed BE in 25/38 patients (64.1%). At 5 years, two patients had proven BE. Concerning the incidence of BE post NSG: 234 performed the follow-up endoscopy within 2 years. The incidence of de novo BE is nil. CONCLUSION: The NSG is associated with healing of known BE in approximately two-thirds of patients at 2-year follow-up. This is consistent with the GERD improvement that has been shown with NSG.

A Video-Based Review of Important Technical Concepts in the Nissen-Sleeve Gastrectomy.

PURPOSE: The development of gastroesophageal reflux disease (GERD) is a commonly encountered scenario after sleeve gastrectomy. A recently reported technical amendment to incorporate a Nissen fundoplication is discussed in this multimedia article focussing on optimising outcomes and reducing complications. MATERIALS AND METHODS: An intraoperative video has been edited to demonstrate the Nissen-Sleeve Gastrectomy and important technical considerations in its technical performance. RESULTS: Gastrolysis is performed proximally from 6 cm proximal to the pylorus. Routine full mediastinal mobilisation of the oesophagus (5 cm) is completed. Cruroplasty is routinely performed. A short Nissen fundoplication is completed calibrated on a 37 French bougie and then sleeve gastrectomy is performed. Our team's experience suggests that careful manipulation of the fundus and using reproducible measurements of the fundus are key to completing the fundoplication whilst minimising complications. A control test with mobilisation of the bougie through the wrap is recommended at the end of the procedure. CONCLUSION: The Nissen-Sleeve Gastrectomy, as presented in this video, is safe and has good short-term efficacy outcomes. Longer term and randomised studies are ongoing.