Late complications of biliopancreatic diversion in an older patient: a case report

Abstract

Background In the mid-seventies, biliopancreatic diversion became popular as weight-loss surgery procedure. This bariatric procedure combines distal gastric resection and intestinal malabsorption, leading to greater weight loss and improvement of co-morbidities than other bariatric procedures. Nowadays, biliopancreatic diversion has become obsolete due to the high risk of nutritional complications. However, current patients with biliopancreatic diversions are aging. Consequently, geriatricians and general practitioners will encounter them more often and will be faced with the consequences of late complications. Case presentation A 74-year old female presented with weakness, recurrent falls, confusion, episodes of irresponsiveness, anorexia and weight loss. Her medical history included osteoporosis, herpes encephalitis 8 years prior and a biliopancreatic diversion (Scopinaro surgery) at age 52. Cerebral imaging showed herpes sequelae without major atrophy. Delirium was diagnosed with underlying nutritional deficiencies. Biochemical screening indicated vitamin A deficiency, vitamin E deficiency, zinc deficiency and severe hypoalbuminemia. While thiamin level and fasting blood glucose were normal. However, postprandial hyperinsulinemic hypoglycemia was observed with concomitant signs of confusion and blurred consciousness. After initiating parenteral nutrition with additional micronutrient supplementation, a marked improvement was observed in cognitive and physical functioning. Conclusions Long-term effects of biliopancreatic diversion remain relatively underreported in older patients. However, the anatomical and physiological changes of the gastrointestinal tract can contribute to the development of metabolic and nutritional complications that may culminate in cognitive impairment, functional decline and delirium. Therefore, it is warranted to evaluate the presence of metabolic disturbances and nutritional complications in older patients after biliopancreatic diversion.

Do All Bariatric Surgery Methods Have the Same Effects on the Gut Microbiota?

“…Among the existing bariatric methods, biliopancreatic diversion (BPD) was common in prior decades. It is a combination of a Roux-en-Y construction with a distal gastrectomy [30]. Biliary and pancreatic juices are transported by the biliopancreatic limb to the common limb, while ingested food is transferred to the common limb by the alimentary limb [30].…”

“…It is a combination of a Roux-en-Y construction with a distal gastrectomy [30]. Biliary and pancreatic juices are transported by the biliopancreatic limb to the common limb, while ingested food is transferred to the common limb by the alimentary limb [30]. One of the most effective methods in decreasing comorbidities of obesity and weight loss with minimal long-term weight regain is biliopancreatic diversion (BPD) [30,31].…”

“…Biliary and pancreatic juices are transported by the biliopancreatic limb to the common limb, while ingested food is transferred to the common limb by the alimentary limb [30]. One of the most effective methods in decreasing comorbidities of obesity and weight loss with minimal long-term weight regain is biliopancreatic diversion (BPD) [30,31]. Patients lose weight because of the reduction in the area of absorption by bypassing most of the intestines with nutrients, also because of reduced absorption and digestion by the attachment of nutrients to the biliopancreatic enzymes and secretions distally [32].…”

“…BPD, which is surgically challenging, is rarely performed today due to the high risk of lifelong needs and nutritional complications for follow-up [29]. Presently, late complications are frequently observed in elderly patients [30].…”

Microbiota dynamics preceding bariatric surgery as obesity treatment: a comprehensive review

“…BPD combines gastric bypass with distal gastrectomy, resulting in a reduced intestinal absorption area and nutritional malabsorption ( 16 ). While BPD is highly effective for weight loss and improving metabolic comorbidities, it also raises the risk of long-term complications such as protein and vitamin deficiencies ( 17 , 18 ).…”