ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2017) 49 EP576 | DOI: 10.1530/endoabs.49.EP576

Severe diabetic gastroparesis - two cases of challenging treatment

Pedro Souteiro1,2, Sofia Castro Oliveira1,2, João Sérgio Neves1,2, João Santos-Antunes2, Rita Bettencourt-Silva1,2, Sandra Belo1,2, Celestino Neves1,2, Paula Freitas1,2, Joana Queirós1, César Esteves1,2 & Davide Carvalho1,2

1Department of Endocrinology, Diabetes and Metabolism, Porto, Portugal; 2Faculty of Medicine of University of Porto, Porto, Portugal.

Introduction: Gastroparesis is defined by a delayed gastric emptying without mechanical obstruction. It can be a debilitating complication of diabetes that is poorly understood and has limited therapeutic options.

Case reports: 1st case - We report the case of a 34-year-old woman with type 1 diabetes mellitus (T1DM) with diabetic nephropathy and gastroparesis, and a reasonable glycaemic control (haemoglobin A1c 6.9%) on insulin-pump regimen. Gastric emptying scan revealed 100% contrast retention 2 hours after its ingestion, confirming severe gastroparesis. Repeated vomiting, refractory to oral anti-emetics, led to her hospitalization 8 times in one year in a total of 109 days. She also underwent a medical pregnancy interruption due to hyperemesis gravidarum. Due to difficult management of vomits the patient underwent a gastric peroral endoscopic pyloromyotomy (G-POEM). After the procedure she had pronounced symptomatic improvement and reduced need of hospitalization (only 10 days in the 6 months of follow-up). The post-procedure scan showed a near-normal gastric emptying (52% contrast retention at 2 hours).

2nd case - A 23-year-old woman with T1DM with diabetic gastroparesis with no other end-organ damage. She presented a poor glycaemic control with a haemoglobin A1c of 10.3%. Gastric scan revealed severe retention with a half-emptying time of 862.6 minutes (normal time of 80±20). She was severely disabled by vomit episodes that required frequent and prolonged hospitalization periods. She also underwent G-POEM with fair symptomatic improvement and reduced need of hospitalization during her follow-up despite post-procedure gastric scanning still showed a delayed gastric emptying (93% retention at 2 hours).

Conclusions: Diabetic gastroparesis presents a challenging treatment since medical therapy has disappointing results in some patients. In those cases, endoscopic procedures can lead to symptomatic relief and enhanced quality of life obviating the need of more aggressive alternatives like gastrectomy.