Electron microscopic observation of gastric mucosal capillaries in diabetics--relationship between diabetic microangiopathy and complications following gastrectomy.

An electron microscopic study was made of the gastric mucosal capillaries (GMC) of diabetic patients. Ultrastructural findings, including diabetic microangiopathy (DMA), and clinical features of these diabetic patients were investigated in relation to anastomotic leakage after gastrectomy. The gastric mucosa of resected stomachs from 12 diabetics and 10 nondiabetics were examined. Ultrastructurally, DMA was demonstrated in the stomachs of diabetics, in which the basement membrane of GMC was thicker. The degree of this DMA in the stomach significantly correlated with the duration of diabetes and the degree of DMA found in the skin, but not with age and fasting plasma glucose (FPG) level. Marked DMA was observed with significant frequency in diabetics with anastomotic leakage after gastrectomy. In our hospital, anastomotic leakage after gastrectomy occurred in 9 out of 53 diabetics. Diabetics with anastomotic leakage had severe FPG, a long duration of diabetes and diabetic retinopathy. It seems reasonable to presume that anastomotic leakage after gastrectomy occurs more frequently in diabetics with ultrastructurally severe DMA, clinically severe FPG and relatively long duration of diabetes.