• Skip to main content
  • Skip to header right navigation
  • Skip to site footer

Log in
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
www.sages.org

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Awards
    • Who Is SAGES?
    • Leadership
    • Our Mission
    • Advocacy
    • Committees
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Committee Rosters
      • SAGES Past Presidents
  • Meetings
    • SAGES NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2026 Scientific Session Call for Abstracts
      • 2026 Emerging Technology Call for Abstracts
    • CME Claim Form
    • SAGES Past, Present, Future, and Related Meeting Information
    • SAGES Related Meetings & Events Calendar
  • Join SAGES!
    • Membership Application
    • Membership Benefits
    • Membership Types
      • Requirements and Applications for Active Membership in SAGES
      • Requirements and Applications for Affiliate Membership in SAGES
      • Requirements and Applications for Associate Active Membership in SAGES
      • Requirements and Applications for Candidate Membership in SAGES
      • Requirements and Applications for International Membership in SAGES
      • Requirements for Medical Student Membership
    • Member Spotlight
    • Give the Gift of SAGES Membership
  • Patients
    • Join the SAGES Patient Partner Network (PPN)
    • Patient Information Brochures
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find A SAGES Surgeon
  • Publications
    • Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Sustainability in Surgical Practice
    • SAGES Stories Podcast
    • Patient Information Brochures
    • Patient Information From SAGES
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • MesSAGES – The SAGES Newsletter
    • COVID-19 Archive
    • Troubleshooting Guides
  • Education
    • Wellness Resources – You Are Not Alone
    • Avoid Opiates After Surgery
    • SAGES Subscription Catalog
    • SAGES TV: Home of SAGES Surgical Videos
    • The SAGES Safe Cholecystectomy Program
    • Masters Program
    • Resident and Fellow Opportunities
      • MIS Fellows Course
      • SAGES Robotics Residents and Fellows Courses
      • SAGES Free Resident Webinar Series
      • Fluorescence-Guided Surgery Course for Fellows
      • Fellows’ Career Development Course
    • SAGES S.M.A.R.T. Enhanced Recovery Program
    • SAGES @ Cine-Med Products
      • SAGES Top 21 Minimally Invasive Procedures Every Practicing Surgeon Should Know
      • SAGES Pearls Step-by-Step
      • SAGES Flexible Endoscopy 101
    • SAGES OR SAFETY Video Activity
  • Opportunities
    • Fellowship Recognition Opportunities
    • SAGES Advanced Flexible Endoscopy Area of Concentrated Training (ACT) SEAL
    • Multi-Society Foregut Fellowship Certification
    • Research Opportunities
    • FLS
    • FES
    • FUSE
    • Jobs Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • OWLS/FLS
You are here: Home / Abstracts / Management of Refractory Diabetic Gastroparesis: Too Pace Or Bypass?

Management of Refractory Diabetic Gastroparesis: Too Pace Or Bypass?

J Roberto Ramirez, MD, Daniel A Guerron, MD, Bipand Chand, MD. Cleveland Clinic Foundation

BACKGROUND
Diabetic gastroparesis (DGP) affects up to 40% of patients with type 1 diabetes and up to 30% of patients with type II diabetes. DGP typically causes nausea, vomiting, early satiety, bloating, and postprandial fullness. The standard treatment of symptomatic DGP consists of tight glycemic control (glucose levels, <150 mg/dL), dietary manipulation, and medications. If those nonsurgical therapies fail, therapy may consist of gastric pacer implantation (Enterra).
The exact mechanisms of how gastric bypass (GBP) impacts body weight and glucose metabolism are incompletely understood. The rearranged anatomy of GBP facilitates the entry of food into the jejunum, bypassing the remaining neuroendocrine and physiologically functional stomach, duodenum and proximal jejunum. Obesity-related diseases dramatically resolve or improve after bariatric surgery including diabetes resolution ranging from 60-85%.
At our center, we have successfully adopted laparoscopic gastric pacer for refractory DGP. However, patients with morbid obesity with obesity related co-morbidities and severe diabetic gastroparesis remain under studied.
METHODS
We report our experience of four patients with severe medical refractory diabetic gastroparesis and morbid obesity. All patients underwent an extensive pre-surgical workup that included biochemistry evaluations, upper endoscopy, radiographic imaging, and functional studies including four hour solid phase gastric emptying studies. All four patients had medical management for their DM through an endocrinologist and suffered from gastroparesis for greater than five years managed by a gastroenterologist. Two patients met criteria and underwent gastric pacing and two had standard laparoscopic gastric bypass, based on NIH criteria. Data analyzed included improvement in gastroparesis symptoms, glycemic control, body mass index change and co-morbidity change. The two patients that underwent gastric pacing had poor symptom control after one year of frequent gastric pacer interrogating and subsequently underwent gastric bypass with removal of the gastric neuroregulator and gastric leads.
RESULTS
All four subjects were females with a mean age of 43 y/o (range 37 to 54y/o), mean body mass index of 36.8 kg/m² (range 35.7 to 38.59). All underwent laparoscopic gastric bypass and additionally had a gastric remnant tube placed into the gastric remnant. The intent of remnant tube placement was to avoid complications from acute remnant distention and provide decompression in order to improve symptoms. Remnant tube placement resulted in partial improvement of gastroparetic symptoms in 3 of the 4 patients. All subsequently underwent gastric remnant resection to provide attempts at long term symptom control. All patients reported significant improvements in nausea, vomiting, bloating, oral intake and overall quality of life. Median BMI was 25 kg/m² at 1 year follow up. Median BMI preprocedure was 36.2 kg/m². Glycemic control as measured by fasting glucose was 155mg/dl. Other co morbidity improvement includes but not limited to anxiety, GERD, osteoarthritis.
CONCLUSIONS
The management of severe DGP in the morbidly obese patient remains challenging. Laparoscopic gastric bypass appears to offer superior glycemic control which may in turn improve gastroparetic symptoms. Remnant resection at the time of gastric bypass may offer increased symptom control. Increased studies are required to help delineate exact mechanisms of action and provide an appropriate treatment algorithm.


Session: Poster
Program Number: P277
View Poster

249

Share this:

  • Click to share on X (Opens in new window) X
  • Click to share on Facebook (Opens in new window) Facebook
  • Click to share on LinkedIn (Opens in new window) LinkedIn
  • Click to share on Pinterest (Opens in new window) Pinterest
  • Click to share on WhatsApp (Opens in new window) WhatsApp
  • Click to share on Reddit (Opens in new window) Reddit
  • Click to share on Pocket (Opens in new window) Pocket
  • Click to share on Mastodon (Opens in new window) Mastodon
  • Click to share on Threads (Opens in new window) Threads
  • Click to share on Bluesky (Opens in new window) Bluesky

Related


sages_adbutler_leaderboard

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064

1-310-437-0544

[email protected]

Monday – Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Bluesky
  • X
  • Instagram
  • Facebook
  • YouTube

Copyright © 2025 · SAGES · All Rights Reserved

Important Links

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals