The Use of Gastrostomy Tube for the Long-Term Remission of Hyperinsulinemic Hypoglycemia After Roux-en-y Gastric Bypass: A Case Report

ABSTRACT Objective: Hyperinsulinemic hypoglycemia is an increasingly reported complication of Roux-en-Y gastric bypass surgery (RYGB), for which there is currently no acceptable treatment. We present a case of the reversal of severe hyperinsulinemic hypoglycemia through gastrostomy tube (GT) feeding to the remnant stomach and uniquely report the durable resolution of neuroglycopenic symptoms 3 years after GT placement. Methods: The case subject underwent standardized postprandial measurement of plasma glucose, insulin, glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic peptide (GIP), and glucagon concentrations after oral or GT administration of a standardized liquid meal. Results: Hypersecretion of insulin, GLP-1, and glucagon elicited by oral administration of the liquid meal were reversed with GT feeding. GIP was not secreted in excess of normal after the oral meal. Conclusion: This case of reversible hyperinsulinemic hypoglycemia through GT feeding illustrates the physiology of this disorder, pointing to an exaggerated GLP-1 response due to rapid nutrient transit to the distal bowel. The sustained resolution of the case subject's neuroglycopenic symptoms supports the use of GT as an effective and durable treatment for severe refractory hyperinsulinemic hypoglycemia after RYGB. Abbreviations: GIP glucose-dependent insulinotropic peptide GLP-1 glucagon-like peptide-1 GT gastrostomy tube RYGB Roux-en-Y gastric bypass