Differences in glycemic trends due to reconstruction methods after proximal gastrectomy from the perspective of continuous glucose-monitoring

Katsutoshi Shoda; Takeshi Kubota; Yoshihiko Kawaguchi; Hidenori Akaike; Suguru Maruyama; Yudai Higuchi; Takashi Nakayama; Ryo Saito; Koichi Takiguchi; Shinji Furuya; Kensuke Shiraishi; Hidetake Amemiya; Hiromichi Kawaida; Daisuke Ichikawa

doi:10.1007/s00595-024-02845-7

Differences in glycemic trends due to reconstruction methods after proximal gastrectomy from the perspective of continuous glucose-monitoring

Surg Today. 2024 Apr 23. doi: 10.1007/s00595-024-02845-7. Online ahead of print.

Affiliations

¹ First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 4093898, Japan. shoda@koto.kpu-m.ac.jp.
² Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 6028566, Japan.
³ First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 4093898, Japan.

PMID: 38649530
DOI: 10.1007/s00595-024-02845-7

Abstract

Purpose: In recent years, clinicians have focused on the importance of preventing hypoglycemia. We evaluated the impact of different reconstruction procedures after proximal gastrectomy on glycemic variability in non-diabetic patients with gastric cancer.

Methods: This prospective observational study was conducted between April 2020 and March 2023. Flash continuous glucose-monitoring, a novel method for assessing glycemic control, was used to evaluate the glycemic profiles after gastrectomy. A flash continuous glucose-monitoring sensor was placed subcutaneously at the time of discharge, and glucose trends were evaluated for 2 weeks.

Results: The anastomotic methods for proximal gastrectomy were esophagogastrostomy in 10 patients and double-tract reconstruction in 10 patients. The time below this range (glucose levels < 70 mg/dL) was significantly higher in the double-tract reconstruction group than in the esophagogastrostomy group (p = 0.049). A higher nocturnal time below this range was significantly correlated with an older age and double-tract reconstruction (p = 0.025 and p = 0.025, respectively).

Conclusion: These findings provide new insights into reconstruction methods after proximal gastrectomy by assessing postoperative hypoglycemia in non-diabetic patients with gastric cancer.

Keywords: Continuous glucose-monitoring; Gastric cancer; Glucose fluctuations; Hypoglycemia; Proximal gastrectomy.