Obstructive Gastroparesis: Patient Selection and Effect of Laparoscopic Pyloroplasty

Wellington, Jennifer; Stuart, Paula; Westcott, Carl; Koch, Kenneth L.

doi:10.1007/s11605-019-04240-x

Cited by 7 publications

(9 citation statements)

References 18 publications

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“…In theory, surgical management of gastroparesis is based on the underlying mechanism of dysfunction. Patients with periods of high pyloric outflow resistance, known as pylorospasm, should ideally be managed with pyloric drainage procedures, such as pyloroplasty or G-POEM [6][7][8][9][10]. By contrast, those with antral hypomotility as the chief mechanism of their gastroparesis would benefit the most from gastric stimulator [6][7][8][9].…”

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confidence: 99%

“…Patients with periods of high pyloric outflow resistance, known as pylorospasm, should ideally be managed with pyloric drainage procedures, such as pyloroplasty or G-POEM [6][7][8][9][10]. By contrast, those with antral hypomotility as the chief mechanism of their gastroparesis would benefit the most from gastric stimulator [6][7][8][9]. In practice, however, the ability to distinguish between these phenotypes is limited by technology and a paucity of data on surgical outcome predictors.…”

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confidence: 99%

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Predictors of favorable outcome after pyloroplasty for gastroparesis: should response to pyloric dilation or Botox injection be used as a marker of surgical outcome?

et al. 2023

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Introduction Pyloroplasty and gastric peroral endoscopic myotomy (G-POEM) are effective surgeries for gastroparesis. The primary aim of this study was to evaluate outcomes of pyloroplasty and G-POEM in patients with gastroparesis and determine factors associated with favorable outcome. The secondary aim was to assess the utility of clinical response to preoperative pyloric dilation or botulinum toxin injection (Botox) on surgical outcome, a factor conventionally used as a favorable marker. Methods There were 204 patients who underwent pyloroplasty (n = 177) or G-POEM (n = 27) for gastroparesis at our institution from 2014 to 2021. Demographic and clinical parameters were analyzed to assess their impact on surgical outcome. A subgroup of patients who had pyloric dilation or Botox injection were assessed separately. Favorable outcome was defined as patient reported complete resolution of the predominant gastroparesis symptom. Results Favorable outcome was achieved in 78.4% of patients (pyloroplasty: 79.7% and G-POEM: 70.4%, p = 0.274). Among 61 patients where pre- and postoperative gastric emptying studies (GES) were available, mean 4-hour retention significantly improved from 33.5 to 15.0% (p < 0.001) and 77.0% of patients achieved normalization. Favorable outcome was not significantly impacted by etiology of gastroparesis (p = 0.120), GERD (p = 0.518), or primary gastroparesis symptom (p = 0.244). Age ≥ 40 was a significant predictor of favorable surgical outcome on multivariate analysis [OR: 2.476 (1.224–5.008), p = 0.012]. Among the patients who had preoperative dilation (n = 82) or Botox injection (n = 46), response to these interventions was not a predictor of favorable surgical outcome (p = 0.192 and 0.979, respectively). However, preoperative Botox injection, regardless of response to injection, was associated with favorable surgical outcome [OR: 3.205 (CI 1.105–9.299), p = 0.032]. Conclusion Symptomatic improvement after pyloroplasty or G-POEM is independent of etiology of gastroparesis, GERD, and primary symptom. Response to dilation or Botox are not markers of response to surgery. However, patients who receive Botox are 3.2 times more likely to improve postoperatively. Graphical abstract

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Predictors of favorable outcome after pyloroplasty for gastroparesis: should response to pyloric dilation or Botox injection be used as a marker of surgical outcome?

et al. 2023

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“…had used cutaneous EGG with water load satiety test proved that pyloric balloon dilation improved symptoms and gastric emptying long term in obstructive GP. Wellington et al (29). used a similar approach to show that pyloric dysfunction is a key factor in the development of functional obstructive GP and to develop a rational method for screening patients who would benefit most from surgery.…”

Section: Traditional Serosal Electrodes and Cutaneous Electrodesmentioning

confidence: 99%

Endoscopic mucosal electrodes: New directions for recording and regulating gastric myoelectric activity

Han

Zhu

2023

Front. Surg.

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With the gradual deepening of the study of gastric motility disorders, people increasingly realize that gastric myoelectric activity plays an important role in coordinating gastric function. This article introduces the advantages of endoscopic mucosal electrodes compared with traditional electrodes. Several different types of mucosal electrodes and how to fix the electrodes by endoscope are introduced. Endoscopic mucosal electrodes can record and regulate gastric myoelectric activity, which has great value in the study of gastric motility. Endoscopic mucosal electrode technique refers to the fixation of the electrode in the designated part of the gastric mucosa by endoscope. Through endoscopic mucosal electrodes, on the one hand, we can record gastric myoelectric activity, on the other hand, we can carry out gastric electrical stimulation to interfere with gastric rhythm. Endoscopic mucosal electrodes have higher accuracy than traditional cutaneous electrodes, less trauma and lower cost than serosal electrodes. Endoscopic mucosal electrodes have a good application prospect for diseases such as gastroparesis and obesity.

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“…For example, subsets of patients with GP and normal 3 cpm GMA and dysrhythmic GMA in response to a standard water load satiety test can be identified [6][7][8] ; furthermore, patients with 3 cpm GMA have decreased symptoms and improved emptying after pyloric therapies. 7,8 These studies utilized standard single channel electrogastrography, recorded with a device developed at Penn State University, and cleared by the FDA. The device reproducibly measures frequency and amplitudes of normal 3 cpm GMA and dysrhythmic GMA (tachygastrias, bradygastrias, and mixed dysrhythmias) in response to a standard provocative test meal.…”

Section: E T T E R T O T H E E D I T Omentioning

confidence: 99%

“…Second, the clinical usefulness of determining GMA is emerging. For example, subsets of patients with GP and normal 3 cpm GMA and dysrhythmic GMA in response to a standard water load satiety test can be identified [6][7][8] ; furthermore, patients with 3 cpm GMA have decreased symptoms and improved emptying after pyloric therapies. 7,8 These studies utilized standard single channel electrogastrography, recorded with a device developed at Penn State University, and cleared by the FDA.…”

Section: E T T E R T O T H E E D I T Omentioning

confidence: 99%

Carson DA, O’Grady G, Du P, Gharibans AA, Andrews CN. Body surface mapping of the stomach: New directions for clinically evaluating gastric electrical activity. Neurogastroenterol Mot. 2021;33:e14048

Koch

2021

Neurogastroenterology Motil

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Obstructive Gastroparesis: Patient Selection and Effect of Laparoscopic Pyloroplasty

Cited by 7 publications

References 18 publications

Predictors of favorable outcome after pyloroplasty for gastroparesis: should response to pyloric dilation or Botox injection be used as a marker of surgical outcome?

Predictors of favorable outcome after pyloroplasty for gastroparesis: should response to pyloric dilation or Botox injection be used as a marker of surgical outcome?

Endoscopic mucosal electrodes: New directions for recording and regulating gastric myoelectric activity

Carson DA, O’Grady G, Du P, Gharibans AA, Andrews CN. Body surface mapping of the stomach: New directions for clinically evaluating gastric electrical activity. Neurogastroenterol Mot. 2021;33:e14048

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