Surgeons Pioneer New Modality to Treat Diabetes

An innovative new way to treat diabetes is based on a technique used in bariatric surgery, improving blood glucose levels and addressing a major complication of the disease.

Researchers at New York-Presbyterian Hospital/Columbia University Medical Center (New York, NY, USA) have adapted sleeve gastrectomy--a surgical technique first developed for weight-loss surgery-- in the treatment of gastroparesis, a diabetes-related condition in which the stomach is unable to empty its contents into the intestines. The technique, also known as a gastric sleeve or vertical or longitudinal gastrectomy, reduces the stomach to approximately 30% of its original size.


So far, four patients who underwent sleeve gastrectomy in 2010 all had diabetes with severe gastroparesis; for various reasons, they were not eligible to receive a gastric pacemaker. After surgery, two of the patients did very well right away, and the other two needed nutritional support for several months. At six months after surgery, all four were eating and drinking and were no longer experiencing nausea or vomiting. Unlike implantation of a gastric pacemaker, sleeve gastrectomy leaves no foreign object in the body and does not require battery changes.

“We had previously observed that after sleeve gastrectomy, patients who had difficulty emptying their stomachs showed significant improvement in their digestion,” said Melissa Bagloo, MD, who leads the gastroparesis program at NYP. “We do not know precisely why this is; sleeve gastrectomy may have the effect of 'resetting' the natural gastric pacemaker, or it may be that the smaller size of the stomach increases intragastric pressure so that it helps facilitate gastric emptying. We believe that laparoscopic sleeve gastrectomy may be a less-invasive option that allows patients to eat normally and regain their quality of life.”

Gastroparesis symptoms can include pain, nausea, vomiting, abdominal bloating, and malnutrition. Although a number of conditions may cause gastroparesis, the most common is diabetes. In this case, continued high blood sugar levels damage the vagus nerve, which controls the movement of food through the digestive tract. Conventional treatments may include medical therapies, dietary changes, and implantation of a gastric electrical stimulator (gastric pacemaker), a device that helps to control nausea and vomiting. If all of these fail to help, however, patients may have no choice but to receive nutrients through feeding tubes.

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NewYork-Presbyterian Hospital/Columbia University Medical Center