NEW YORK - 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.
Sleeve gastrectomy corrects diabetes complication
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
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
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.
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
According to Dr. Bagloo, "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.
Unlike implantation of a
gastric pacemaker, sleeve gastrectomy leaves no foreign object in the
body and does not require battery changes. Although other surgeries have
been attempted in patients with gastroparesis, they are larger
operations with significant risks, says Dr. Bagloo. "We believe that
laparoscopic sleeve gastrectomy may be a less-invasive option that
allows patients to eat normally and regain their quality of life."
other medical center has reported using sleeve gastrectomy to treat
gastroparesis. Based on the success in the initial four patients,
NewYork-Presbyterian/Columbia is conducting further study. The Center
for Metabolic and Weight Loss Surgery concurrently is developing a
program that will offer all treatments, including gastric pacemakers and
sleeve gastrectomy, for patients with gastroparesis.
Gastric bypass reverses Type 2 diabetes
at the Center for Metabolic and Weight Loss Surgery are offering
weight-loss surgery for the treatment of Type 2 diabetes as part of an
ongoing clinical trial. Their research has helped show that gastric
bypass is a safe and effective way to treat the disease by improving
blood glucose levels, reducing or even eliminating the need for
medication and lowering risk for diabetes-related death.
breakthrough approach can put diabetes into remission for most patients
and promises to transform the way we treat this disease," says Dr. Marc
Bessler, director of the Center for Metabolic and Weight Loss Surgery at
NewYork-Presbyterian/Columbia and professor of clinical surgery at
Columbia University College of Physicians and Surgeons.
surgery is also being studied at the Diabetes Surgery Center at
NewYork-Presbyterian Hospital/Weill Cornell Medical Center under the
direction of Dr. Francesco Rubino.
This article was originally published at www.newswise.com.