Surgical Therapy of Diabetic Gastroparesis

Reardon, Thomas M.; Schnell, Gregory A.; Smith, Owen J.; Schubert, Timothy T.

doi:10.1097/00004836-198904000-00018

Cited by 30 publications

(17 citation statements)

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“…Interestingly, gastric resection is also associated with less than encouraging outcomes and is used only as a last resort. [12][13][14][15] Another surgical intervention for gastroparesis is an implantable gastric stimulator (Enterra, Medtronic, Shoreview, MN). The gastric stimulator consists of a subcutaneous pulse generator connected to two electrical leads that are surgically secured to the anterior stomach wall near the greater curvature.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic and Endoscopic Pyloroplasty for Gastroparesis Results in Sustained Symptom Improvement

Hibbard

Dunst

Swanström

2011

Journal of Gastrointestinal Surgery

159

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Section: Discussionmentioning

confidence: 99%

Laparoscopic and Endoscopic Pyloroplasty for Gastroparesis Results in Sustained Symptom Improvement

Hibbard

Dunst

Swanström

2011

Journal of Gastrointestinal Surgery

159

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“…However, in a more recent study, the same team has reported poor outcomes with GES in more than 50% of the long-standing DGP patients who have sustained an irreversible loss of their intrinsic network of interstitial cells of Cajal, the 'gastric pacemaker' (11). More invasive approaches to treat refractory gastroparesis include pyloroplasty with or without vagotomy and partial or total gastrectomy (12).…”

Section: Introductionmentioning

confidence: 99%

Intrapyloric Injection of Botulinum Toxin A for the Treatment of Persistent Gastroparesis Following Successful Pancreas Transplantation

Ben‐Youssef

Baron

Franco

et al. 2006

American Journal of Transplantation

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Intrapyloric injection of botulinum toxin A (BoTx) successfully improved symptoms in idiopathic and diabetic gastroparesis (DGP) refractory to medical treatment. Therefore, we used it in three pancreas transplant patients done in our institution during the last 18 months. They had severe, persistent DGP despite successful pancreas transplantation. They received 100 units of BoTx during the first injection. The clinical effect became evident within 2 weeks after the treatment, and lasted for an average of 29 weeks (range 14-44 weeks). The patients' subjective evaluation showed improvement of their symptoms and quality of life following BoTx. Patients 2 and 3 had recurrent symptoms at 44 and 24 weeks, respectively, after the first injection; they required a second dose of 90 and 80 units, respectively. They are doing well at 3 months followup. Intrapyloric injection of BoTx is safe and efficient. It should be considered for treating residual DGP following successful pancreas transplantation.

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“…If those approaches fail, palliative surgical therapies include tube gastrostomy for decompression and jejunostomy for feeding. Other surgical options have focused on improving GE with pyloroplasty and antrectomy (8). Total gastrectomy remains the ultimate surgical option (9).…”

mentioning

confidence: 99%

Treatment of Diabetic Gastroparesis by High-Frequency Gastric Electrical Stimulation

Lin

Forster²,

Sarosiek³

et al. 2004

Diabetes Care

171

153

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OBJECTIVE -To investigate the long-term efficacy of high-frequency gastric electrical stimulation (GES) for treating diabetic gastroparesis. RESEARCH DESIGN AND METHODS-This is a retrospective review of 48 adult diabetic patients with refractory gastroparesis who had a GES system implanted surgically and had follow-up evaluations at 6 and 12 months. The outcome measures were total symptom score (TSS), derived from six upper gastrointestinal (GI) symptom subscores; health-related quality of life (HQOL), including physical composite score (PCS) and mental composite score (MCS) assessed by SF-36 questionnaire, radionuclide gastric emptying test, nutritional status, HbA 1c , and adverse events.RESULTS -In comparison with baseline, TSS, all six upper GI symptom subscores, PCS, and MCS were significantly improved at 6 months, with the improvement sustained at 12 months. Of 13 patients receiving nutritional support at baseline by tube feeding, only 5 required supplemental enteral feeding at 12 months, and none of the 9 on total parenteral nutrition continued this support. The mean number of hospitalization days during the year after GES was significantly reduced by 52 days compared with the prior year. HbA 1c levels were significantly reduced at 12 months. Gastric emptying was only minimally and not significantly faster. Because of infections at the pulse generator pocket site, four patients had their GES systems removed 3-17 months postsurgery.CONCLUSIONS -In diabetic patients with refractory gastroparesis, high-frequency GES by a permanently implanted system significantly improved upper GI symptoms, HQOL, nutritional status, glucose control, and hospitalizations with an acceptably low complication rate.

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Surgical Therapy of Diabetic Gastroparesis

Cited by 30 publications

References 0 publications

Laparoscopic and Endoscopic Pyloroplasty for Gastroparesis Results in Sustained Symptom Improvement

Laparoscopic and Endoscopic Pyloroplasty for Gastroparesis Results in Sustained Symptom Improvement

Intrapyloric Injection of Botulinum Toxin A for the Treatment of Persistent Gastroparesis Following Successful Pancreas Transplantation

Treatment of Diabetic Gastroparesis by High-Frequency Gastric Electrical Stimulation

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