New ways for treating 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.

Sleeve Gastrectomy Corrects Diabetes Complication

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.

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."

No 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

Surgeons 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.

"This 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.