Fig 1 - available via license: Creative Commons Attribution-NonCommercial 4.0 International
Content may be subject to copyright.
Gastric emptying study in a patient with diabetic gastroparesis. (A) Preoperative gastric emptying time is significantly delayed. (B) Postoperative gastric emptying time is normal.
Source publication
The role of surgical intervention in patients with diabetic gastroparesis is unclear. We report a case of a 37-year-old man with a history of recurrent episodes of vomiting and long-standing type 2 diabetes mellitus. Esophagogastroduodenoscopy did not reveal any findings of reflux esophagitis or obstructive lesions. A gastric emptying time scan sho...
Contexts in source publication
Context 1
... also underwent a gastric emptying time scan, which indicated delayed gastric emptying (gastric emptying half-time of 344 minutes) (Fig. ...
Context 2
... showed complete resolution of gastrointestinal symptoms, and he was discharged on the 6th postoperative day after an uneventful postoperative course. A barium swallow esophagogastrography and a gastric emptying time scan performed for follow-up evaluation of the gastrointestinal tract showed regular barium progression and normal gastric emptying (Fig. 1B) The most common causes of gastroparesis, excluding idiopathic etiology, include diabetes and surgery [2]. Although the true prevalence of gastroparesis is unknown, reduced gastric motility is not rare in patients with a history of long-standing ...
Citations
... Despite being considered a more radical approach, partial or total gastrectomy, roux-en Y gastric bypass are also done in severe cases [155,156]. The aim is to eliminate dysfunctional gastric reservoir allowing food to bypass the non-functioning stomach, improving symptoms and nutrient absorption. ...
... Several studies have reported hormonal changes in various lengths of biliopancreatic limbs 22,23 . In order to maximize the effect of this hormonal change, long limb Roux-en-Y gastrectomy was performed to improve T2DM, and positive results were reported in several studies [24][25][26] . ...
The rates of early gastric cancer and type 2 diabetes mellitus(T2DM) are sharply increasing in Korea. Oncometabolic surgery in which metabolic surgery is conducted along with cancer surgery is a method used to treat gastric cancer and T2DM in one-stage operation. From 2011 to 2019, a total of 48 patients underwent long-limb Roux-en-Y gastrectomy (LRYG) in Inha University Hospital, and all data were reviewed retrospectively. A 75 g oral glucose tolerance test and serum insulin level test were performed before and 1 week and 1 year after surgery. One year after LRYG operation, 25 of 48 patients showed complete or partial remission and 23 patients showed non-remission of T2DM. The preoperative HbA1c level was significantly lower and the change in HbA1c was significantly greater in the T2DM remission group. Insulin secretion indices(insulinogenic index and disposition index) were increased significantly in the T2DM remission group. In contrast, the insulin resistance indices (homeostatic model assessment of insulin resistance (HOMA-IR) and Matsuda index) changed minimal. In the case of LRYG in T2DM patients, remnant β cell function is an important predictor of favorable glycemic control.
Background
Management of refractory gastroparesis is challenging after diet, prokinetics and long-term nutritional support has failed.
Objectives
In this review, efficacy and safety of surgical interventions (sleeve gastrectomy/Roux-en-Y gastric bypass surgery) is evaluated systematically in patients with refractory gastroparesis.
Methods
Pubmed, Embase and Scopus databases were searched to identify relevant studies published up to June 2021. Outcome of interest was symptom improvement and gastric emptying.
Results
Nineteen studies with 222 refractory gastroparesis patients (147 Roux-en-Y gastric bypass; 39 sleeve gastrectomy; 36 subtotal gastrectomy) were included. All studies reported symptom improvement post-operatively, particularly vomiting and nausea. Gastric emptying improved post-operatively in 45% up to 67% for sleeve gastrectomy and in 87% for Roux-en-Y gastric bypass.
Conclusions
Findings of our systematic review suggest that sleeve gastrectomy and Roux-en-Y gastric bypass surgery improve symptoms and gastric emptying in patients with refractory gastroparesis. Surgery may be effective as treatment for a small group of patients when all other therapies have failed.
