Pyloric distensibility measurement predicts symptomatic response to intrapyloric botulinum toxin injection

Pyloric distensibility measurement after gastric surgery: Which surgeries are associated with pylorospasm?

“…Moreover, it might help to better select patients undergoing treatments targeting pyloric therapies in case of pylorospasm, like botulinum toxin injections or G‐POEM for example . In a previous study including a small number of patients with postfundoplication gastroparesis, it was shown that an altered pyloric distensibility was associated with the symptomatic response to intrapyloric botulinum toxin injections but not a normal pyloric distensibility . Moreover, our results suggest that vagal nerve injury was not present in all patients in the esophagectomy group, which is in contradiction with the performance of systematic vagotomy during laparotomy.…”

“…Even if these results need further confirmatory studies, this is the first evaluation of the percentage of pylorospasm diagnosed using EndoFLIP ® system among patients with dyspeptic symptoms following upper gastrointestinal surgery. We recently reported that pyloric distensibility may be of use to better select patients undergoing intrapyloric botox . Likewise, a previous report suggested that pyloric distensibility could also predict patient outcome after Gastric Per‐Oral Endoscopic Pyloromyotomy (G‐POEM) .…”

“…Two previous studies investigated the potential predictive effect of pyloric distensibility on symptomatic response to pyloric therapies. The first one showed, in a prospective cohort of 35 gastroparetic patients, including six cases of postfundoplication gastroparesis, that decreased pyloric distensibility was associated with a better symptomatic response to intrapyloric botulinum toxin injections . The second one investigated the efficacy of G‐POEM in gastroparetic patients, showing in a small number of patients that decreased pyloric distensibility <9.2 mm 2 /mm Hg was associated with 3‐month clinical efficacy .…”

“…As it reflects vagotomy or gastroparesis, it could be complementary to gastric emptying. Moreover, it might help to better select patients undergoing treatments targeting pyloric therapies in case of pylorospasm, like botulinum toxin injections or G‐POEM for example . In a previous study including a small number of patients with postfundoplication gastroparesis, it was shown that an altered pyloric distensibility was associated with the symptomatic response to intrapyloric botulinum toxin injections but not a normal pyloric distensibility .…”

“…For each set volume, pyloric pressure and pyloric distensibility were measured as previously described . A cut‐off of 10 mm 2 /mm Hg at 40 mL of inflation for normality of distensibility was determined in a previous study in healthy volunteers. Using this threshold value of 10 mm 2 /mm Hg, pyloric distensibility was classified as normal (>10 mm 2 /mm Hg) or decreased (<10 mm 2 /mm Hg).…”