Surgical Treatment for Refractory Gastroparesis: Stimulator, Pyloric Surgery, or Both?

Zoll, Bryan; Jehangir, Asad; Edwards, Michael A.; Petrov, Roman; Malik, Zubair; Parkman, Henry P.

doi:10.1007/s11605-019-04391-x

Cited by 29 publications

(21 citation statements)

References 15 publications

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“…At our center, we perform both stimulator placement and pyloromyotomy procedures in patients with refractory gastroparesis symptoms with delayed gastric emptying. We have found that patients with refractory symptoms of gastroparesis undergoing stimulator placement, pyloromyotomy or combined stimulator with pyloromyotomy each had improvement of their gastroparesis symptoms [8]. However, we found that gastric stimulation improved nausea/vomiting, whereas pyloromyotomy tended to improve early satiety and postprandial fullness.…”

contrasting

confidence: 54%

Which endosurgical treatment for gastroparesis: pyloromyotomy or gastric electrical stimulation?

Parkman

2020

Endoscopy

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There has been a boom in performing pyloromyotomy for gastroparesis over the past 10 years, particularly since endoscopic pyloromyotomy (gastric peroral endoscopic myotomy [G-POEM] or pyloromyotomy [POP]) was introduced. How do we place the use of pyloromyotomy, particularly G-POEM, with other treatments for gastroparesis, particularly gastric electrical stimulation (GES)? Referring to Shen S et al. p. 349-358

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contrasting

confidence: 54%

Which endosurgical treatment for gastroparesis: pyloromyotomy or gastric electrical stimulation?

Parkman

2020

Endoscopy

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“…In our study, patients with improvement in Gp symptoms with TTS pyloric dilation reported symptoms of nausea, vomiting, or loss of appetite improving the most. In a recent study from our Motility Center, Gp patients with chronic refractory symptoms undergoing pyloromyotomy/pyloroplasty experienced significant improvement in their overall Gp symptom severity [22]. However, some Gp patients have symptoms refractory to pyloromyotomy/pyloroplasty and may undergo repeat pyloric surgeries or gastrectomy that may be associated with a considerable morbidity and mortality [23,24].…”

Section: Discussionmentioning

confidence: 99%

“…Additional studies assessing gastric emptying pre-and post-pyloric TTS dilation in gastroparesis patients with symptoms refractory to pyloric surgeries may be beneficial. CPGAS is commonly used to assess clinical improvement in research studies [22,26,35]; however, there have been no official validation studies for this scoring scale. Nonetheless, several of patients' Gp symptoms also had statistically and clinically significant improvement when assessed using the GCSI questionnaire in our study, the validated questionnaire to assess Gp symptoms [25].…”

Section: Discussionmentioning

confidence: 99%

“…Increase in pyloric distensibility after pyloromyotomy corresponds to symptomatic improvement in Gp patients [21]. However, some patients may continue to experience debilitating symptoms of Gp after pyloric surgeries, especially symptoms of nausea and vomiting [22]. These patients with refractory symptoms of Gp may require additional surgeries, such as repeat pyloroplasty or even gastrectomy, which may be associated with considerable risk of postoperative adverse events [23,24].…”

Section: Introductionmentioning

confidence: 99%

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EndoFLIP and Pyloric Dilation for Gastroparesis Symptoms Refractory to Pyloromyotomy/Pyloroplasty

et al. 2020

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Background Gastroparesis patients may undergo pyloromyotomy/pyloroplasty for chronic refractory symptoms. However, some patients have persistent symptoms. It is unknown if balloon dilation may improve their symptoms. Aims We aimed to (1) assess if pyloric through-the-scope (TTS) balloon dilation results in symptom improvement in gastroparesis patients with suboptimal response to pyloromyotomy/pyloroplasty and (2) determine endoscopic functional luminal imaging probe (EndoFLIP) characteristics of these patients before dilation. Methods Patients with severe gastroparesis refractory to pyloromyotomy/pyloroplasty seen from 2/2019 to 3/2020 underwent pyloric TTS dilation after assessing the pyloric characteristics using EndoFLIP. Patients completed Gastroparesis Cardinal Symptom Index (GCSI) pre-procedurally, and GCSI and Clinical Patient Grading Assessment Scale (CPGAS) on follow-ups. Results Thirteen (ten females) patients (mean age 45.2 ± 5.1 years) with severe gastroparesis symptoms (mean GCSI total score 3.4 ± 0.3) after pyloromyotomy/pyloroplasty underwent pyloric TTS dilation. Overall, there was improvement in symptoms at 1-month follow-up (mean GCSI total score 3.0 ± 0.4, mean CPGAS score 1.6 ± 0.5, p < 0.05 for both), with five (38%) patients reporting symptoms somewhat/moderately better. The patients with symptom improvement had lower predilation pyloric EndoFLIP distensibility at 30 ml, 40 ml, and 50 ml than patients with little/no improvement (all p < 0.05). Conclusions In gastroparesis patients with refractory symptoms after pyloromyotomy/pyloroplasty, pyloric TTS dilation improved symptoms in about a third of the patients. Patients with symptom improvement had lower pre-dilation pyloric distensibility on EndoFLIP suggesting incomplete myotomy, pyloric muscle regeneration, or pyloric stricture. Pyloric End-oFLIP followed by TTS dilation seems to be a promising treatment for some patients with gastroparesis symptoms refractory to pyloromyotomy/pyloroplasty.

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“…Although originally developed for achalasia, the POEM procedure has expanded to treat other spastic esophageal motility disorders such as distal esophageal spasm (DES), hypercontractile and hypertensive esophageal peristalsis (jackhammer and nutcracker esophagus) (27,(40)(41)(42)(43)(44)(45)(46)(47)(48). In 2015, Khashab et al retrospectively reported on the efficacy and safety of POEM for the treatment of patients with spastic esophageal disorders (SEDs) (46).…”

Section: Other Applicationsmentioning

confidence: 99%

Peroral endoscopic myotomy: techniques and outcomes

Petrov¹,

Fajardo²,

Bakhos³

et al. 2021

Shanghai Chest

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Surgical Treatment for Refractory Gastroparesis: Stimulator, Pyloric Surgery, or Both?

Cited by 29 publications

References 15 publications

Which endosurgical treatment for gastroparesis: pyloromyotomy or gastric electrical stimulation?

Which endosurgical treatment for gastroparesis: pyloromyotomy or gastric electrical stimulation?

EndoFLIP and Pyloric Dilation for Gastroparesis Symptoms Refractory to Pyloromyotomy/Pyloroplasty

Peroral endoscopic myotomy: techniques and outcomes

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