TITLE

Jejunostomy Tube Placement in Refractory Diabetic Gastroparesis: A Retrospective Review

AUTHOR(S)
Fontana, R. J.; Barnett, J. L.
PUB. DATE
October 1996
SOURCE
American Journal of Gastroenterology;Oct1996, Vol. 91 Issue 10, p2174
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Objectives: Severe diabetic gastroparesis leading to recurrent episodes of diabetic ketoacidosis and frequent hospitalizations can be among the most disabling of all diabetic complications. Surgical placement of a jejunostomy tube (J-tube) beyond the affected stomach to deliver fluid, nutrients, and medication is one of the few therapeutic options remaining in the cohort of patients who have failed standard medical therapy. This study attempts to define the natural history of refractory diabetic gastroparesis and the risks and benefits of J-tube placement. Methods: A total of 26 patients with diabetic gastroparesis requiring J-tube placement were identified between 1980 and 1994. Medical chart review and telephone follow-up were performed using standardized questionnaires. Results: All patients had documented delayed gastric emptying, had failed medical therapy, and had been hospitalized on multiple occasions. Neuropathy, retinopathy, and nephropathy were observed in 88%, 81%, and 65% of patients, respectively. The mean duration of study follow-up was 47 months (1-130 months). The mean age of subjects at the time of J-tube placement was 31 yr, and a preponderance of female patients (73%) was noted. There were 23 major complications in 14 patients requiring surgery or hospitalization and 47 minor complications in 21 patients managed on an outpatient basis. The mean duration of J-tube use was 20 months. There were 10 deaths during follow-up, one related to J-tube placement. Retrospectively, 39% reported improved symptoms of nausea/vomiting (4% worsened), 52% reported fewer hospitalizations (4%, more frequent), 56 % reported improved nutritional status (4% worsened), and 83% reported improved overall health (4% worsened) after J-tube placement. The improvement in overall health status was the only symptom that reached statistical significance. Conclusion: Severe refractory gastroparesis is associated with multiple hospitalizations, a high incidence of...
ACCESSION #
16103779

 

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