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Surgeons Pioneer New Ways to Treat Diabetes

Surgeons at NewYork-Presbyterian Hospital/Columbia University Medical Center are innovating new ways to treat diabetes using techniques from weight-loss surgery, including experimental procedures to improve blood glucose levels and address a major complication of the disease.

NewYork-Presbyterian/Columbia may be the first to use 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. Early results have been promising.

Because patients with gastroparesis cannot move food properly through their digestive system, they may experience symptoms including pain, nausea, vomiting, abdominal bloating and malnutrition. Although a number of conditions may cause gastroparesis, by far 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, or “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.

When four patients with gastroparesis were unable to receive gastric pacemakers, surgeons at NewYork-Presbyterian/Columbia performed sleeve gastrectomy to see if it might help.

The technique, also known as a gastric sleeve or vertical or longitudinal gastrectomy, reduces the stomach to approximately 30 percent of its original size, explains Dr. Melissa Bagloo, who leads the gastroparesis program at NewYork-Presbyterian/Columbia and is assistant professor of clinical surgery at Columbia University College of Physicians and Surgeons.

Dr. Bagloo stated that, “We had previously observed that after sleeve gastrectomy, patients who had difficulty emptying their stomachs showed significant improvement in their digestion. 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. There could also be other reasons why the surgery helps.”

The 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. For patients who faced the prospect of lifelong feeding tubes, the benefits of such a successful outcome cannot be overstated,” says Dr. Bagloo.

 

NewYork-Presbyterian Hospital/Columbia University Medical Center