PET-CT reveals increased intestinal glucose uptake after gastric surgery

• Published in: Surgery for obesity and related diseases Vol. 15; no. 4; pp. 643 - 649
• Main Authors: Franquet, Elisa, Watts, George, Kolodny, Gerald M., Goldfine, Allison B., Patti, Mary-Elizabeth
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2019
• Subjects: 18D-FDG PET-CT; Aged; Aged, 80 and over; Female; Fluorodeoxyglucose F18 - administration & dosage; Fluorodeoxyglucose F18 - metabolism; Fluorodeoxyglucose F18 - pharmacokinetics; Gastrectomy; Gastric Bypass; Gastrointestinal surgery; Glucose metabolism; Humans; Intestinal glucose uptake; Intestine; Intestines - diagnostic imaging; Intestines - physiology; Intestines - surgery; Male; Middle Aged; Positron Emission Tomography Computed Tomography - methods; Postoperative Period; Retrospective Studies; Glucose metabolism; 18D-FDG PET-CT; Intestinal glucose uptake; Gastrointestinal surgery; Intestine
• ISSN: 1550-7289; 1878-7533; 1878-7533
• DOI: 10.1016/j.soard.2019.01.018

•Bariatric and gastric surgery reduces plasma glucose levels, often yielding resolution of type 2 diabetes.•Consistent with prior data from rodent studies, we demonstrate that glucose uptake (determined via 18F-FDG PET-CT) is significantly increased in multiple intestinal segments in individuals with history of bariatric and gastric surgery. Mechanisms of metabolic improvement after bariatric surgery remain incompletely understood. Intestinal glucose uptake is increased after gastric bypass in rodents, potentially contributing to reduced blood glucose and type 2 diabetes remission. We assessed whether intestinal glucose uptake is increased in humans after gastric surgery. University Hospital, United States. In a retrospective, case-control cohort study, positron emission tomography-computerized tomography scans performed for clinical indications were analyzed to quantify intestinal glucose uptake in patients with or without history of gastric surgery. We identified 19 cases, defined as patients over age 18 with prior gastric surgery (Roux-en-Y gastric bypass [n = 10], sleeve gastrectomy [n = 1], or Billroth I [n = 2] or II gastrectomy [n = 6]), and 43 controls without gastric surgery, matched for age, sex, and indication for positron emission tomography-computerized tomography. Individuals with gastrointestinal malignancy or metformin treatment were excluded. Images were obtained 60 minutes after 18F-fluorodeoxyglucose injection (4.2 MBq/kg), and corrected by attenuation; noncontrast low-dose computerized tomography was obtained in parallel. Fused and nonfused images were analyzed; standardized uptake values were calculated for each region by volumes of interest at the region of highest activity. Both standardized uptake values maximum and mean were significantly increased by 41% to 98% in jejunum, ascending, and transverse colon in patients with prior gastric surgery (P < .05 versus controls). Intestinal glucose uptake is increased in patients with prior gastric surgery. Prospective studies are important to dissect the contributions of weight loss, dietary factors, and systemic metabolism, and to determine the relationship with increased insulin-independent glucose uptake and reductions in glycemia.