Surgical treatment of medically refractory gastroparesis in the morbidly obese

Abstract

GES implantation and RYGJ are both effective in terms of symptom control for medically refractory gastroparesis in morbidly obese. Both options can be performed in a minimally invasive fashion with low morbidity. Patients who have no improvement of symptoms for refractory gastroparesis after GES implantation can be successfully converted laparoscopically to RYGJ.

Diagnosis and Management of Gastroparesis

“…The first step to manage gastroparesis is dietary modification including use of small-particle, low-fat, and low-fiber diet along with adequate hydration (16). Patients with gastroparesis with severe malnutrition (weight loss greater than 10% within 6 months of diagnosis), nutrient deficiencies, or frequent hospitalizations may require enteral or, rarely, parenteral nutrition to maintain their nutritional status (14,17,18). Pharmacological therapy failed for this young patient with severe idiopathic gastroparesis and required total parenteral nutrition.…”

Gastroparesis

“…Taking into account older literature, the surgical option in gastroparesis should be considered with caution, and temporary nasointestinal tube feeding can be used to evaluate tolerance of nutrients rapidly entering the small bowel [38]. A number of case series of gastric electrical stimulator insertion for refractory gastroparesis were also published, with response rates of up to 60% [41][42][43]. However, these uncontrolled case series should be considered cautiously, as the two most recent controlled trials with gastric electrical stimulation failed to show significant differences in the blinded periods with stimulator on or off [44,45].…”

Systematic review on sleeve gastrectomy or Roux-en-Y gastric bypass surgery for refractory gastroparesis

“…1). Finally, 19 studies were included in this systematic review, including a total of 222 patients with gastroparesis, of whom 147 patients received Roux-en-Y gastric bypass surgery, reported in 12 studies [17][18][19][20][21][25][26][27][28][29]34,35]; 39 patients underwent sleeve gastrectomy, reported in 5 studies [13,15,16,23,36]; and 36 patients underwent subtotal or near-total gastrectomy, reported in 2 studies [24,37] (Table 1). Eighteen studies were full-text articles, and 1 study was a conference abstract [36].…”

“…Seven studies were case reports [13,15,18,19,25,36,37], and 12 studies were retrospective observational studies [16,17,20,21,23,24,[26][27][28][29]34,35]. Based on NIH quality assessment, 4 studies had good quality, and the other 15 studies were of fair quality (Table 2).…”

“…Proposed mechanisms include a change in gastric distensibility by reducing gastric volume and altered contractility by resetting the gastric pacemaker. Since 2013, several case studies reported on single-center efficacy of gastric surgery in refractory gastroparesis [13,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. Up to the present, randomized studies on the overall efficacy and safety of surgery for gastroparesis are lacking.…”