Shaun C Daly, MD, Mahtab Sohrevardi, MD, Jonathan A Myers, MD, Minh B Luu. Rush University Medical Center
Introduction: Diabetic gastroparesis is an incurable chronic disease and the goal of treatment is to improve quality of life for patients. Laparoscopic sleeve gastrectomy to improve symptoms in patients with severe diabetic gastroparesis has not been described. The faster gastric emptying and better glycemic control following a sleeve gastrectomy should provide symptomatic improvement with lower morbidity than current surgical options. Our aim is to assess the safety and efficacy of laparoscopic sleeve gastrectomy as the initial treatment for the symptoms of severe diabetic gastroparesis.
Methods and Procedures: Inclusion criteria consistent of patients between the ages of 18 and 70 who presented with a diagnosis of either grade 2 or 3 diabetic gastroparesis as determined by the Gastroparesis Cardinal Symptom Index (GCSI) The maximum GSCI score is 45 and a score ≥27 indicate severe disease. All patients underwent preoperative and postoperative gastric emptying study and a preoperative upper endoscopy. Preoperative and postoperative GSCI scores were assessed and compared. The laparoscopic sleeve gastrectomy was performed in a standard fashion but with the use of a 60 French bougie to limit unwanted weight loss. Patient follow-up was initially at 1 week, then at 1, 3, 6, and 12 months.
Results: Three patients underwent laparoscopic sleeve gastrectomy for severe gastroparesis. The mean preoperative GSCI score was 39. At one week follow-up, the mean GSCI score decreased to 24 (-38%), a 1-month mean GSCI scores decreased to 20.5 (-47%), and at 6-months the mean GSCI score decreased to 7 (-82%). Each patient had a progressive decrease in mean GSCI scores. The patient who received a postoperative gastric emptying scan had less retention at 1 hour (80% vs. 50%) and had complete emptying by 2 hours. Mean follow-up was 10 weeks (range: 1-24 weeks).
Discussion: Our early experience with laparoscopic sleeve gastrectomy for symptom control in severe gastroparesis has been promising. In our first three patients we have experienced a decrease in GCSI scores as early as 1 week postoperative with continued improvement at 6 months of follow-up. In addition, our patient who received her 6-month repeat gastric emptying study demonstrated normal emptying at 2 hours. Further patient enrollment and continued follow-up is warranted.