J Gastric Cancer.  2019 Sep;19(3):365-371. 10.5230/jgc.2019.19.e23.

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

• Park JM
• Kim JW
• Chi KC

• KMID: 2458835
• DOI: http://doi.org/10.5230/jgc.2019.19.e23

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.

Keyword

Diabetes mellitus; Gastroparesis; Gastrectomy; Vomiting

MeSH Terms

Adult
Barium
Blood Glucose
C-Peptide
Diabetes Mellitus
Diabetes Mellitus, Type 2
Endoscopy, Digestive System
Esophagitis, Peptic
Fasting
Follow-Up Studies
Gastrectomy*
Gastric Emptying
Gastroparesis*
Hemoglobin A, Glycosylated
Humans
Hypoglycemic Agents
Insulin
Vomiting
Barium
C-Peptide
Hypoglycemic Agents
Insulin

Figure

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  Fig. 1 Gastric emptying study in a patient with diabetic gastroparesis. (A) Preoperative gastric emptying time is significantly delayed. (B) Postoperative gastric emptying time is normal.

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  Fig. 2 Diagrammatic representation of long-limb Roux-en-Y subtotal gastrectomy with longitudinal resection of the stomach.

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