Gastric electric stimulator versus gastrectomy for the treatment of medically refractory gastroparesis

Samaan, Jamil S.; Toubat, Omar; Alicuben, Evan T.; Dewberry, Sean; Dobrowolski, Adrian; Sandhu, Kulmeet; Zehetner, Joerg; Lipham, John C.; Samakar, Kamran

doi:10.1007/s00464-022-09191-0

Cited by 5 publications

(1 citation statement)

References 17 publications

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“…PGS is a rare complication of surgery for esophagus and cardia cancer, which causes acute gastric dilation, affects anastomotic healing, and may even lead to esophagogastric anastomotic stula, bleeding, and infection, thus seriously impairing patients' recovery and prolonging ALOS. At present, the pathogenesis of PGS is unclear, but may be related to a variety of factors such as sympathetic activation, vagus nerve injury, gastric position change, surgical trauma, and stress response [14][15].…”

Section: Discussionmentioning

confidence: 99%

DSA-guided Pyloric Balloon Dilation versus Conservative Medical Treatment for Postsurgical Gastroparesis Syndrome

weiping,

qi,

wenhua

2024

Preprint

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Background To compare the clinical efficacy of DSA-guided pyloric balloon dilation with that of conservative medical treatment for postsurgical gastroparesis syndrome (PGS). Methods The clinical data of 41 patients with PGS, who received DSA-guided pyloric balloon dilation (study group, n=21) or conservative medical treatment(control group, n=20) between January 2012 and February 2021, were retrospectively analyzed. The median follow-up period in the study group and the control group was 588 days and 626 days respectively. The average length of stay (ALOS) was compared between the two groups. Results In the study group, all the 21 patients returned to normal food intake within 2 days after successful DSA-guided pyloric balloon dilationtreatment, and they were all discharged within one week after treatment. The ALOS in the study group was (10.2±1.3) days, which was strikingly shorter than (34.5±14.2) days in the control group. The difference between the two groups was statistically significant (P<0.001). Conclusions For the treatment of PGS, DSA-guided pyloric balloon dilation carries better clinical efficacy when compared with conservative medical treatment. Therefore, it can be used as the preferred treatment for patients with PGS. Further studies are need to be conducted to clarify the therapeutic mechanism.

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Section: Discussionmentioning

confidence: 99%

DSA-guided Pyloric Balloon Dilation versus Conservative Medical Treatment for Postsurgical Gastroparesis Syndrome

weiping,

qi,

wenhua

2024

Preprint

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Outcome of gastric electrical stimulator with and without pyloromyotomy for refractory gastroparesis

Aeschbacher,

Garcia,

Dourado

et al. 2024

Surg Endosc

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Background Surgical treatments of refractory gastroparesis include pyloromyotomy and gastric electrical stimulator (GES). It is unclear if patients may benefit from a combined approach with concomitant GES and pyloromyotomy. Methods Retrospective cohort analysis of all patients with refractory gastroparesis treated with GES implantation with and without concomitant pyloromyotomy at Cleveland Clinic Florida from January 2003 to January 2023. Primary endpoint was efficacy (clinical response duration and success rate) and secondary endpoints included safety (postoperative morbidity) and length of stay. Success rate was defined as the absence of one of the following reinterventions during follow-up: Roux-en-Y gastric bypass (RYGB), pyloromyotomy, GES removal. Results During a period of 20 years, 134 patients were treated with GES implantation. Three patients with history of previous surgical pyloromyotomy or RYGB were excluded from the analysis. Median follow-up was 31 months (IQR 10, 72). Forty patients (30.5%) had GES with pyloromyotomy, whereas 91 (69.5%) did not have pyloromyotomy. Most of the patients had idiopathic (n = 68, 51.9%) or diabetic (n = 58, 43.3%) gastroparesis. Except for preoperative use of opioids (47.5 vs 14.3%; p < 0.001), patient’s characteristics were similar in both groups. There were no significant differences between the two groups in terms of overall postoperative complications (17.5% vs 14.3%; p = 0.610), major postoperative complications (0% vs 2.2%; p = 1), and length of stay (2(IQR 1, 2) vs 2(IQR 1, 3) days; p = 0.068). At 5 years, success rate was higher in patients with than without pyloromyotomy however not statistically significant (82% versus 62%, p = 0.066). Especially patients with diabetic gastroparesis seemed to benefit from pyloromyotomy during GES (100% versus 67%, p = 0.053). In an adjusted Cox regression, GES implantation without pyloromyotomy was associated with a 2.66 times higher risk of treatment failure compared to GES implantation with pyloromyotomy (HR 2.66, 95% CI 1.03–6.94, p = 0.044). Conclusion Pyloromyotomy during GES implantation for gastroparesis seems to be associated with a longer clinical response with similar postoperative morbidity and length of hospital stay than GES without pyloromyotomy. Patient with diabetic gastroparesis might benefit from a combination of GES implantation and pyloromyotomy.

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The role of gastric electrical stimulation in postsurgical gastroparesis: a retrospective analysis from 2 centers

Dadlani,

Naing,

Woldesellassie

et al. 2024

Journal of Gastrointestinal Surgery

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Gastric electric stimulator versus gastrectomy for the treatment of medically refractory gastroparesis

Cited by 5 publications

References 17 publications

DSA-guided Pyloric Balloon Dilation versus Conservative Medical Treatment for Postsurgical Gastroparesis Syndrome

DSA-guided Pyloric Balloon Dilation versus Conservative Medical Treatment for Postsurgical Gastroparesis Syndrome

Outcome of gastric electrical stimulator with and without pyloromyotomy for refractory gastroparesis

The role of gastric electrical stimulation in postsurgical gastroparesis: a retrospective analysis from 2 centers

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