Through-the-scope transpyloric stent placement improves symptoms and gastric emptying in patients with gastroparesis

Clarke, John O.; Sharaiha, Reem Z.; Valeshabad, Ali Kord; Lee, L. A.; Kalloo, Anthony N.; Khashab, Mouen A.

doi:10.1055/s-0032-1326400

Cited by 45 publications

(33 citation statements)

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“…71,72 A guidewire is advanced into the distal duodenum, and the self-expandable metal stent delivery system is placed over the guidewire. The stent is deployed under endoscopic visualization, such that the proximal flared end is in the antrum and the distal flared end in the duodenum proximal to the duodenal papilla.…”

Section: Pyloric Interventionsmentioning

confidence: 99%

Novel Diet, Drugs, and Gastric Interventions for Gastroparesis

Camilleri

2016

Clinical Gastroenterology and Hepatology

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This review of the pathophysiological basis for gastroparesis and recent advances in the treatment of patients with gastroparesis shows that there are several novel approaches to advance treatment of gastroparesis including diet, novel prokinetics, interventions on the pylorus, and novel forms of gastric electrical stimulation. The field of gastroparesis is likely to advance with further studies, with the help from a guidance document from the FDA on gastroparesis, and with the recent approval of the stable isotope gastric emptying test to ensure eligibility of participants in multicenter trials. Clinical experience and a formal, randomized, controlled trial provide insights on optimizing dietary interventions in patients with gastroparesis. This review addresses the biological rationale of these different treatments, based on known physiology and pathophysiology of gastric emptying. The novel medications include the motilin agonist, camicinal, 5-HT4 receptor agonists such as velusetrag, and the ghrelin agonist, relamorelin. New approaches target pylorospasm by either stent placement, endoscopic pyloric myotomy or laparoscopic pyloroplasty. These approaches offer the opportunity to achieve more permanent reduction of resistance to flow at the pylorus over the intrapyloric injection of botulinum toxin, which typically has to be repeated every few months if it is efficacious. A novel device, deployed in porcine stomach, involved per-endoscopic electrical stimulation. These promising approaches require formal, randomized, controlled trials and deployment in patients. The presence of concomitant antral hypomotility may be a significant factor in the responsiveness to interventions at the pylorus.

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Section: Pyloric Interventionsmentioning

confidence: 99%

Novel Diet, Drugs, and Gastric Interventions for Gastroparesis

Camilleri

2016

Clinical Gastroenterology and Hepatology

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“…Transpyloric stenting is another endoscopic technique that has been described. Although it has been shown anecdotally to yield symptomatic relief [9], it is prone to stent migration, and is unlikely to provide a viable long-term solution. Operative techniques of pyloric disruption for the treatment of gastroparesis have mainly consisted of a Heineke-Miculicz pyloroplasty.…”

Section: Introductionmentioning

confidence: 99%

Early human experience with per-oral endoscopic pyloromyotomy (POP)

et al. 2014

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“…31,32 Two retrospective uncontrolled case series have been conducted investigating transpyloric stenting. 33,34 The largest case series 34 included 30 patients who underwent transpyloric stent placement for refractory nausea and vomiting. The study did not demonstrate a statistically significant difference in clinical symptoms with treatment, despite the presence of a statistically significant improvement in gastric emptying.…”

Section: Update and Discussion Of Recent Studiesmentioning

confidence: 99%