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Guidelines for gastrostomy tube placement and enteral nutrition in patients with severe, refractory hypoglycemia after gastric bypass.
Zanley, Elizabeth; Shah, Neha D; Craig, Colleen; Lau, James N; Rivas, Homero; McLaughlin, Tracey.
Afiliação
  • Zanley E; Department of Medicine, Stanford University, Stanford, California.
  • Shah ND; Department of Clinical Nutrition, Stanford Health Care, Stanford, California.
  • Craig C; Department of Medicine, Stanford University, Stanford, California.
  • Lau JN; Department of General Surgery, Stanford University, Stanford, California.
  • Rivas H; Department of General Surgery, Stanford University, Stanford, California.
  • McLaughlin T; Department of Medicine, Stanford University, Stanford, California. Electronic address: tmclaugh@stanford.edu.
Surg Obes Relat Dis ; 17(2): 456-465, 2021 Feb.
Article em En | MEDLINE | ID: mdl-33160876
BACKGROUND: Postbariatric hypoglycemia (PBH) affects up to 38% of Roux-en-Y gastric bypass (RYGB) patients. Severe cases are refractory to diet and medications. Surgical treatments including bypass reversal and pancreatectomy are highly morbid and hypoglycemia often recurs. We have developed a highly effective method of treatment by which enteral nutrition administered through a gastrostomy (G) tube placed in the remnant stomach replaces oral diet: if done correctly this reverses hyperinsulinemia and hypoglycemia, yielding substantial health and quality of life benefits for severely affected patients. OBJECTIVES: To provide clinical guidelines for placement of a G-tube to treat postRYGB hypoglycemia, including candidate selection, preoperative evaluation, surgical considerations, and post-RYGB management. SETTING: Stanford University Hospital and Clinics. METHODS: Based on our relatively large experience with placing and managing G-tubes for PBH treatment, an interdisciplinary task force developed guidelines for practitioners. RESULTS: A team approach (endocrinologist, dietitian, surgeon, psychologist) is recommended. Appropriate candidates have a history of RYGB, severe hypoglycemia refractory to medical-nutrition therapy, and significantly affected quality of life. Preoperative requirements include education and expectation setting, determination of initial enteral feeding program, and establishing service with a home enteral provider. Close postoperative follow-up is needed to ensure success and may require adjustments in formula and mode/rate of delivery to optimize tolerance and meet nutritional goals. G-tube nutrition must fully replace oral nutrition to prevent hypoglycemia. CONCLUSIONS: G-tube placement in the remnant stomach represents a relatively well-tolerated and effective treatment for severe, refractory hypoglycemia after RYGB.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Obesidade Mórbida / Derivação Gástrica / Hipoglicemia Tipo de estudo: Etiology_studies / Guideline Limite: Humans Idioma: En Ano de publicação: 2021 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Obesidade Mórbida / Derivação Gástrica / Hipoglicemia Tipo de estudo: Etiology_studies / Guideline Limite: Humans Idioma: En Ano de publicação: 2021 Tipo de documento: Article