Pyloroplasty for Refractory Gastroparesis

Mancini, Sheri A.; Angelo, Jillian L.; Peckler, Zachary; Philp, Frances Hite; Farah, Katie

doi:10.1177/000313481508100726

Cited by 48 publications

(21 citation statements)

References 29 publications

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“…1 Pyloroplasties have been performed for years and pyloric botulinum toxin injections have been employed for two decades to improve gastric emptying in affected patients. [2][3][4][5][6] Gastric per-oral endoscopic myotomy (G-POEM) has been described in recent case series and systemic reviews for gastroparesis therapy. [7][8][9][10] Impedance planimetry measured by the Functional Lumen Imaging Probe (EndoFLIP) can quantify several pyloric motor parameters.…”

Section: Introductionmentioning

confidence: 99%

“…In an older manometry study, diabetics with gastroparesis exhibited increased phasic and tonic pyloric activity—a phenomenon termed pylorospasm 1 . Pyloroplasties have been performed for years and pyloric botulinum toxin injections have been employed for two decades to improve gastric emptying in affected patients 2‐6 . Gastric per‐oral endoscopic myotomy (G‐POEM) has been described in recent case series and systemic reviews for gastroparesis therapy 7‐10 …”

Section: Introductionmentioning

confidence: 99%

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Impact of gastric per‐oral endoscopic myotomy on static and dynamic pyloric function in gastroparesis patients

Watts

Baker

Lee

et al. 2020

Neurogastroenterology Motil

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Background: Functional Lumen Imaging Probe (EndoFLIP) tests typically measure static pyloric parameters, but the pylorus exhibits phasic variations on manometry. Dynamic changes in pyloric function have not been quantified using EndoFLIP, and the impact of Gastric Per-Oral Endoscopic Myotomy (G-POEM) on static and dynamic pyloric activity in gastroparesis is unknown. Methods: EndoFLIP balloon inflation to 30, 40, and 50 mL was performed to measure mean, maximum, and minimum values and variability in pyloric diameter and distensibility before and after G-POEM in 20 patients with refractory gastroparesis. The impact of phasic contractions on these pyloric measures was compared. Key Results: G-POEM increased mean (P < .0001) and maximum (P = .0002) pyloric diameters and mean (P = .02) and maximum (P = .02) pyloric distensibility on 50 mL EndoFLIP inflation but not intraballoon pressures or minimum diameters or distensibility. Temporal variability of pyloric diameter (P = .02) and distensibility (P = .02) also increased after G-POEM. Phasic coupled contractions propagating from the antrum through the pylorus were observed in 37.5% of recordings; other phasic activity including isolated pyloric contractions were seen in 23.3%. Variability of pyloric diameter and distensibility tended to be higher during recordings with phasic activity. Some pyloric responses to G-POEM were influenced by age, gastroparesis etiology, gastric emptying, and prior botulinum toxin injection. Conclusions & Inferences: Pyloric activity exhibits dynamic changes on EndoFLIP testing in gastroparesis. G-POEM increases maximal but not minimal diameter and distensibility with increased variations, suggesting this therapy enhances pyloric opening but may not impair pyloric closure. Phasic pyloric contractions contribute to variations in pyloric activity.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of gastric per‐oral endoscopic myotomy on static and dynamic pyloric function in gastroparesis patients

Watts

Baker

Lee

et al. 2020

Neurogastroenterology Motil

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“…Vagal nerve injury may be involved in the pathogenesis of gastroparesis [8, 14, 15]. During pylorus preserving gastrectomy, if vagal nerve injury is unavoidable, additional pyloroplasty may be a good choice, in order to reduce the incidence of PSG [16, 17]. However, pyloroplasty is not the first choice for PSG due to the trauma of a second operation.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic effect of a temporary transpyloric stent in refractory post-surgical gastroparesis: a case report

Liang

Zhang

et al. 2019

BMC Surg

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Background Gastroparesis is a syndrome characterized by delayed gastric emptying with associated symptoms. It was reported that the symptoms of diabetic gastroparesis had been greatly improved by transpyloric stent placement. However, the use of stents in benign conditions is considered to be contraindicated because of the increasing risk of complications, such as stent migration, reflux, perforation, bleeding, and, most importantly, new strictures caused by stent-induced tissue hyperplasia. While temporary placement of a self-expanding metallic stent (SEMC) can drastically reduce the risk of complications, few reports are available on the treatment of refractory PSG by temporary transpyloric stent. Does it have a long-term clinical effect after the stent being retrieved? Case presentation After accepting partial resection of the lesser curvature in another hospital, a patient developed refractory gastroparesis. The symptoms hadn’t been improved after long-term drug therapy and balloon dilation therapy. Four months after surgery, a fully covered SEMC was placed by endoscopy in our hospital. Gastroparesis had been greatly improved. Two weeks later, the transpyloric stent was retrieved and the patient didn’t show recurrent symptoms. Follow-ups were arranged at 3 months, 6 months and 1 year respectively, and there was no evidence of recurrence was found. Conclusions This case indicates that temporary transpyloric SEMC is a safe, effective and less invasive alternative for post-surgical gastroparesis patients.

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“…In a recent study, a combination of GES placement and pyloroplasty has been shown to produce significant acceleration of gastric emptying and improvement in symptoms 132 . Laparoscopic pyloromyotomy alone has also been found to be beneficial in regard to improvement in symptoms and gastric emptying rate in GP 133 . Other surgical interventions to relieve symptoms of GP include subtotal gastrectomy or gastric bypass in individuals with morbid obesity 39 .…”

Section: Nonpharmacological Interventionsmentioning

confidence: 99%

Gastroparesis in the Hospital Setting

Rangan

Ukleja

2020

Nut in Clin Prac

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Gastroparesis (GP) is commonly seen in hospitalized patients. Refractory vomiting and related dehydration, electrolyte abnormalities, and malnutrition are indications for hospital admission. In addition, tube feeding intolerance is a common sign of gastric dysmotility in critically ill patients. The diagnosis and management of GP in the hospital setting can be quite challenging. Diagnostic tests are often deferred because of patient intolerance of the oral meal for standard scintigraphy or severity of the primary disease. The diagnosis of GP is often established on the basis of clinical scenario and risk factors for gastric motor dysfunction. Medical therapy in GP is directed toward controlling nausea and vomiting by prokinetic and antinausea medications and correcting nutrition risks or treating malnutrition with nutrition therapy. Enteral nutrition is the preferred nutrition intervention for patients with GP. Delayed gastric emptying in critically ill patients has a negative impact on the timely delivery of enteral feeding and meeting the energy and protein goals. Measures to improve gastric tolerance or provide feeding beyond the stomach are often needed, since early enteral nutrition has been an important target of therapy for critically ill patients. This review will address the current understanding of the mechanisms of GP and feeding intolerance in critical illness, diagnostic workup, drug therapies, and interventions to improve the provision of enteral nutrition in hospital settings when gastric dysmotility is present or suspected.

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Pyloroplasty for Refractory Gastroparesis

Cited by 48 publications

References 29 publications

Impact of gastric per‐oral endoscopic myotomy on static and dynamic pyloric function in gastroparesis patients

Impact of gastric per‐oral endoscopic myotomy on static and dynamic pyloric function in gastroparesis patients

Therapeutic effect of a temporary transpyloric stent in refractory post-surgical gastroparesis: a case report

Gastroparesis in the Hospital Setting

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