Erschienen in:
01.10.2016 | Case Report
Treatment of diabetic gastroparesis with botulinum toxin injection guided by endoscopic ultrasound in a patient with type 1 diabetes: the first report
verfasst von:
Heming Guo, Chen Fang, Yun Huang, Honghong Zhang, Xiaohong Chen, Duanming Hu, Ji Hu
Erschienen in:
Acta Diabetologica
|
Ausgabe 5/2017
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Excerpt
Diabetic gastroparesis is a well-recognized diabetic automatic neuropathy characterized by the delay of gastric emptying without gastric outlet obstruction. Upper gastrointestinal symptoms have been reported by up to 19 % of diabetic patients, and 48–65 % of these patients have been shown to have diabetic gastroparesis [
1]. The cardinal symptoms include postprandial fullness, nausea, vomiting, and bloating. These symptoms caused by diabetic gastroparesis may result in malnutrition, malabsorbtion, impaired glucose control, and a poor quality of life. Patients with refractory diabetic gastroparesis who experience severe symptoms are not able to maintain sufficient nutritional intake and easily cause ketosis. Previous study revealed that diabetic gastroparesis was associated with higher mortality, morbidity, increased hospitalizations, emergency department, and doctor visits [
2]. Primary treatment for diabetic gastroparesis includes correction of exacerbating factors, nutritional support, pharmacologic therapy, and surgical therapy. However, these options for patients have limitations such as high recurrence rate and various side effects. Botulinum toxin A injection is an alternative option for the treatment of diabetic gastroparesis by reducing intrapyloric muscular tone. Botulinum toxin A injection into the pyloric muscle was usually guided by endoscopies in previous studies. The limitations of endoscopic botulinum toxin A injection include uncertain depth of injection and the potential risk of perforation. Here, we present a case of intrapyloric botulinum toxin A injection guided by endoscopic ultrasound (EUS) in a patient with diabetic gastroparesis. …