[Abstract] OBJECTIVE: To summarize the treatment experience of gastroparesis after diabetic gastric diversion. METHODS: To compile the case data of diabetic gastric diversion in our department, and to summarize the treatment methods and risk factors of 14 cases with symptoms of gastroparesis. RESULTS: The onset of postoperative gastroparesis ranged from 8 to 11 days, and the main symptoms were vomiting (containing bile) and abdominal distension, etc. Through the integrated implementation of effective measures such as Chinese medicine and pharmacotherapy, the symptoms were cured within 3 weeks in all cases, of which 28,6% (4/14) were cured within 7 days, 42,9% (6/14) were cured within 7 -28,6% (4/14) were cured within 7 days, 42,9% (6/14) were cured within 7 days, 28,6% (4/14) were cured within 14-21 days. Conclusion: Cases of gastroparesis after diabetic gastric diversion should be treated promptly and prevented actively. 【Key words】gastroparesis; diabetes mellitus; gastric diversion Gastric diversion was first used in clinical practice for weight loss in obese patients, but in a large number of clinical practice, it was found that most cases were suffering from diabetes mellitus at the same time, and the effect of blood glucose control could be achieved through the operation with faster effect, therefore, after continuous clinical practice research, gastric diversion has been applied to the treatment of diabetes mellitus. The cure rate of this method has been reported to be 80% in foreign literature [1], after which this procedure has attracted the attention of scholars worldwide, who are dedicated to the exploration of its mechanism of action. The medical workers in China have also done a lot of research in this area, and it has been found that the surgery can improve the islet function of the cases [2], but some cases will have complications such as gastroparesis. In this paper, we will compile the data of 310 cases of diabetic gastric diversion performed in our department from 2009, 10 to 2012, 5, and summarize the treatment methods and risk factors of 14 cases with symptoms of gastroparesis. 1. Data and methods 1.1 Clinical data The data of 14 cases of diabetic gastric diversion in our department were compiled, of which 14 cases showed symptoms of gastroparesis, with a mean age of 48.5 years (32-65 years), 9 women and 5 men, and a mean disease duration of 4.8 years (0.7-13 years). Comorbidities: 57,1% (8/14) suffered from obesity, 42,9% (6/14) from coronary heart disease, 21,4% (3/14) from renal disease and 42,9% (6/14) from hypertension. The time range of onset of postoperative gastroparesis was 8-11 days, and the symptoms of the disease were: daily gastric drainage of more than 900 ml, vomiting (containing bile), abdominal distension, and epigastric pressure, which could exclude obstruction. 1,2 Methods 1,2,1 Preoperative prophylaxis: prevention and exclusion of high-risk factors that may lead to gastroparesis before surgery, control of glycemic range, and effective treatment if other comorbidities are present in the case. Individualized anastomosis selection was performed to avoid phenomena such as anastomotic stenosis. 1,2,2 Intraoperative prevention: pay attention to the protection of the stomach during the operation, which should not be too strong and needs to avoid stimulation of the gastric wall, as well as to prevent injury to its vagus nerve. 1, 2, 3 Basic therapy: Use a gastric tube for a period of time after surgery, implement parenteral nutrition, prohibit transoral ingestion, do not drink water, and give routine gastrointestinal decompression to prevent metabolic disorders. Intragastric lavage was performed regularly (at intervals not exceeding 24 h), and the mixed liquid (100 ml) used contained a solute mainly dexamethasone, and the solvent was saline (5%), with a concentration ratio of 1 mg/30 ml. 1,2,4 Pharmacotherapy: pharmacotherapy was used while operating according to basic therapy, and drugs with the effect of promoting gastrointestinal motility were selected for a course of 5 days. The drugs used in 10 of the patients were mosapride (Lipobili malate) and morpholine, which were injected 3 times a day through the gastric tube, all at a dose of 10 mg/dose (Lipobili malate 0, 68 mg/dose), and vitamin B1 was provided for the 4 cases with more severe disease, using the foot Sanli point closed (Chinese medicine) at a dose of 20 mg/day, 10 mg/dose, and Da Cheng Qi Tang with addition of mannitol 9g Rhubarb 9g Citrus aurantium 12g Chuanpo 12g decoction in water 100ml, and kept in the gastric tube for 2-3 hours, with gastroscopy for exploration, among the remaining 4 cases, 2 cases were injected with neostigmine at a dose of 30mg/day, 10mg/time along with the above drugs; 2 cases were dosed with erythromycin only, which was dissolved in sodium chloride injection at a dose of 200mg/time. 2, Results Through the comprehensive implementation of a variety of effective measures, the disease was cured in all cases within 3 weeks, with the majority of cases cured in 7-14 days (42, 9%), and the specific treatment time is shown in Table 1. 3, Discussion 3, 1 Predisposing factors of gastroparesis There are many predisposing factors of gastroparesis, and the main ones that have been paid attention to so far are gastric wall irritation, mental factors, vagus nerve damage, etc. Only by mastering the predisposing factors can we prevent and exclude them at an early stage so as to avoid the occurrence of gastroparesis. Gastric wall irritation mainly occurs during surgery, mostly due to prolonged or heavy surgery. The mental factor refers to a psychological state of the patient during the treatment, and the heavier the adverse emotion, the greater the impact. The role of the vagus nerve is to promote gastric emptying, which can be prolonged if damaged during surgery. In addition, the physical condition of the patient will also affect the possibility of gastroparesis, which is generally more likely to occur in cases of poor physical condition such as malnutrition [1]. 3.2 Analysis of prevention methods Complication prevention should be done before performing gastric diversion surgery, strengthening the control of blood glucose range, giving effective treatment if other comorbidities exist in the case, and paying attention to the protection of the stomach during intraoperative operations. At the same time, we pay attention to the combination of various treatment measures, such as the simultaneous use of basic therapy, pharmacotherapy and Chinese medicine, etc. Through the implementation of basic therapy, we can give conventional gastrointestinal decompression and maintain the gastric environment to prevent metabolic disorders; through the implementation of pharmacotherapy, we can effectively promote gastrointestinal peristalsis and improve the functionality of the stomach; through the implementation of Chinese medicine, we can stimulate the “foot three li “This acupuncture point is often chosen by TCM practitioners for the treatment of abdominal organs and has the effect of strengthening the digestive function [3]. Gastroscopy can be used for exploration while treatment is being performed, which is effective in improving local smooth muscle in addition to being able to grasp the lesions in the stomach [4]. The cases in this paper were all cured within 3 weeks with the above treatment, of which 28,6% (4/14) were cured within 7 days, 42,9% (6/14) were cured between 7-14 days and 28,6% (4/14) were cured between 14-21 days, therefore, clinical implementation of diabetic gastric diversion should be done with active prevention and comprehensive treatment.