DOI QR코드

DOI QR Code

Long-limb Roux-en-Y Reconstruction after Subtotal Gastrectomy to Treat Severe Diabetic Gastroparesis

  • Park, Joong-Min (Department of Surgery, Chung-Ang University College of Medicine) ;
  • Kim, Jong Won (Department of Surgery, Chung-Ang University College of Medicine) ;
  • Chi, Kyong-Choun (Department of Surgery, Chung-Ang University College of Medicine)
  • Received : 2019.03.25
  • Accepted : 2019.06.22
  • Published : 2019.09.30

Abstract

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 showed prolonged gastric emptying half-time (344 minutes) indicating delayed gastric emptying. Laboratory tests revealed elevated fasting serum glucose and glycosylated hemoglobin (HbA1c, 12.9%) and normal fasting C-peptide and insulin levels. We performed Roux-en-Y reconstruction after subtotal gastrectomy to treat gastroparesis and improve glycemic control, and the patient showed complete resolution of gastrointestinal symptoms postoperatively. Barium swallow test and gastric emptying time scan performed at follow-up revealed regular progression of barium and normal gastric emptying. Three months postoperatively, his fasting serum glucose level was within normal limits without the administration of insulin or oral antidiabetic drugs with a reduced HbA1c level (6.9%). Long-limb Roux-en-Y reconstruction after subtotal gastrectomy may be useful to treat severe diabetic gastroparesis by improving gastric emptying and glycemic control.

Keywords

References

  1. Horowitz M, Wishart JM, Jones KL, Hebbard GS. Gastric emptying in diabetes: an overview. Diabet Med 1996;13:S16-S22. https://doi.org/10.1002/dme.1996.13.s6.16
  2. Rabine JC, Barnett JL. Management of the patient with gastroparesis. J Clin Gastroenterol 2001;32:11-18. https://doi.org/10.1097/00004836-200101000-00005
  3. Tog C, Liu DS, Lim HK, Stiven P, Thompson SK, Watson DI, et al. Risk factors for delayed gastric emptying following laparoscopic repair of very large hiatus hernias. BJS Open 2017;1:75-83. https://doi.org/10.1002/bjs5.11
  4. McCallum RW, Polepalle SC, Schirmer B. Completion gastrectomy for refractory gastroparesis following surgery for peptic ulcer disease. Long-term follow-up with subjective and objective parameters. Dig Dis Sci 1991;36:1556-1561. https://doi.org/10.1007/BF01296397
  5. Ejskjaer NT, Bradley JL, Buxton-Thomas MS, Edmonds ME, Howard ER, Purewal T, et al. Novel surgical treatment and gastric pathology in diabetic gastroparesis. Diabet Med 1999;16:488-495. https://doi.org/10.1046/j.1464-5491.1999.00086.x
  6. Bell DS, Ovalle F. Gastroparesis cured by gastrectomy. Diabetes Care 1999;22:1000-1001. https://doi.org/10.2337/diacare.22.6.1000
  7. Watkins PJ, Buxton-Thomas MS, Howard ER. Long-term outcome after gastrectomy for intractable diabetic gastroparesis. Diabet Med 2003;20:58-63. https://doi.org/10.1046/j.1464-5491.2003.00872.x
  8. Rubino F, Nathan DM, Eckel RH, Schauer PR, Alberti KG, Zimmet PZ, et al. Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by International Diabetes Organizations. Diabetes Care 2016;39:861-877. https://doi.org/10.2337/dc16-0236
  9. Mingrone G, Panunzi S, De Gaetano A, Guidone C, Iaconelli A, Nanni G, et al. Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet 2015;386:964-973. https://doi.org/10.1016/S0140-6736(15)00075-6
  10. Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Aminian A, Brethauer SA, et al. Bariatric surgery versus intensive medical therapy for diabetes - 5-year outcomes. N Engl J Med 2017;376:641-651. https://doi.org/10.1056/NEJMoa1600869
  11. Pilone V, Tramontano S, Di Micco R, Monda A, Hasani A, Izzo G, et al. Gastric emptying after sleeve gastrectomy: statistical evidence of a controlled prospective study with gastric scintigraphy. Minerva Chir 2013;68:385-392.
  12. Arthur LE, Slattery L, Richardson W. Tailored approach to gastroparesis significantly improves symptoms. Surg Endosc 2018;32:977-982. https://doi.org/10.1007/s00464-017-5775-7