Effects of gastrogastric fistula repair on weight loss and gut hormone levels

Ciaran S. O'Brien, Gary Wang, James McGinty, Keesandra K. Agénor, Roxanne Dutia, Antonia Colarusso, Koji Park, Ninan Koshy, Blandine Laferrère

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Background: Weight regain after gastric bypass (GBP) can be associated with a gastrogastric fistula (GGF), in which a channel forms between the gastric pouch and gastric remnant, allowing nutrients to pass through the "old route" rather than bypassing the duodenum. To further understand the mechanisms by which GGF may lead to weight regain, we investigated gut hormone levels in GBP patients with a GGF, before and after repair. Materials and Methods: Seven post-GBP subjects diagnosed with GGF were studied before and 4 months after GGF repair. Another cohort of 22 GBP control subjects without GGF complication were studied before and 1 year post-GBP. All subjects underwent a 50-g oral glucose tolerance test and blood was collected from 0-120 min for glucose, insulin, ghrelin, PYY3-36, GIP, and GLP-1 levels. Results: Four months after GGF repair subjects lost 6.0 ± 3.9 kg and had significantly increased postprandial PYY3-36 levels. After GGF repair, fasting and postprandial ghrelin levels decreased and were strongly correlated with weight loss. The insulin response to glucose also tended to be increased after GGF repair, however no concomitant increase in GLP-1 was observed. Compared to the post-GBP group, GLP-1 and PYY3-36 levels were significantly lower before GGF repair; however, after GGF repair, PYY 3-36 levels were no longer lower than the post-GBP group. Conclusions: These data utilize the GGF model to highlight the possible role of duodenal shunting as a mechanism of sustained weight loss after GBP, and lend support to the potential link between blunted satiety peptide release and weight regain.

Original languageEnglish
Pages (from-to)1294-1301
Number of pages8
JournalObesity Surgery
Issue number8
StatePublished - Aug 2013
Externally publishedYes


  • GLP-1
  • Gastric bypass
  • Gastrogastric fistula
  • Ghrelin
  • PYY
  • Weight loss


Dive into the research topics of 'Effects of gastrogastric fistula repair on weight loss and gut hormone levels'. Together they form a unique fingerprint.

Cite this