Long-term outcome after gastrectomy for intractable diabetic gastroparesis.

AIMS: To examine the long-term outlook for patients with intractable vomiting from diabetic gastroparesis who underwent major gastric surgery.
METHODS: Of 18 patients with problems from vomiting referred to the King's Diabetes Centre during the years 1994-2000, seven were considered to suffer irreversible symptoms not alleviated by protracted periods of medical treatment. They were all Type 1 Caucasian diabetic women, mean age 32 years (range 28-37 years) with multiple symptoms of severe autonomic neuropathy. They underwent major gastric surgery comprising 70% gastric resection including pylorus and antrum, with a 60-cm Roux-en-Y loop of jejunum to prevent reflux gastritis.
RESULTS: The vomiting was relieved in six of the seven patients almost immediately after surgery and during review up to more than 6 years post-operatively. There have been no serious relapses, resulting in considerable improvement in quality of life. Unfortunately, three of the patients developed renal failure, two of them needing renal support treatments 2 and 3 years after successful gastrectomy. One patient died suddenly 5 months after successful surgery and one 3 months after starting dialysis.
CONCLUSIONS: Major gastric surgery can, after careful patient selection, effectively relieve distressing vomiting from severe gastroparesis and give a greatly improved quality of life to a small group of seriously disadvantaged patients where risk of subsequent renal failure is high and where life expectancy is poor.