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Per-Oral Pyloromyotomy (POP) for Medically Refractory Post-Surgical Gastroparesis

  • 2018 SSAT Plenary Presentation
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Post-surgical gastroparesis (psGP) is putatively related to vagal denervation from either therapeutic transection or inadvertent injury. Here, we present a series of patients undergoing endoscopic per-oral pyloromyotomy (POP) as a treatment for medically refractory psGP.

Methods

Patients identified from a prospectively maintained database of patients undergoing POP procedures at our institution from January 2016 to January 2018 were included. Surgical history, symptom scores, and gastric emptying studies before and 3 months after POP were additionally recorded.

Results

During the study period, 177 POP procedures were performed, of which 38 (21.5%) were for psGP. The study cohort was 84.2% female with a mean body mass index of 27.6 kg/m2 and mean age of 55.2 years. Common comorbidities included hypertension (34.2%), depression (31.6%), and gastroesophageal reflux disease (28.9%). Hiatal/paraesophageal hernia repair (39.5%) or fundoplication (36.8%) preceded psGP diagnosis most often. The mean operative time was 30 ± 20 min. There were no intraoperative complications. Mean postoperative length of stay was 1.2 days. There were two readmissions within 30 days, one for melena and one for dehydration. The mean improvement in total Gastroparesis Symptom Index Score was 1.29 (p = 0.0002). The mean 4-h gastric retention improved from a pre-POP mean of 46.4 to 17.9% post-POP. Normal gastric emptying was noted in 50% of subjects with available follow-up imaging.

Conclusion

POP is a safe and effective endoscopic therapy for patients with psGP. POP should be considered a reasonable first-line option for patients with medically refractory psGP and may allow stomach preservation.

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Authors and Affiliations

  1. Department of General Surgery, Cleveland Clinic, Desk A-100, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Andrew T. Strong, Joshua P. Landreneau, Matthew D. Kroh, John H. Rodriguez, Jeffrey L. Ponsky & Kevin El-Hayek

  2. Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA

    Andrew T. Strong, Joshua P. Landreneau, Michael Cline, Matthew D. Kroh, John H. Rodriguez, Jeffrey L. Ponsky & Kevin El-Hayek

  3. Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA

    Michael Cline

  4. Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates

    Matthew D. Kroh

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  1. Andrew T. Strong
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  2. Joshua P. Landreneau
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Contributions

All the authors agree to be accountable to contents of manuscript.

Andrew Strong: study concept and design, data collection, statistical analysis, initial draft of abstract and manuscript, final approval of manuscript.

Joshua Landreneau: study concept and design, data collection and analysis, final approval of manuscript.

Michael Cline: study concept and design, data collection, critical appraisal of manuscript, final approval of manuscript.

Matthew Kroh: data collection, critical appraisal of manuscript, final approval of manuscript.

John Rodriguez: data collection, critical appraisal of manuscript, final approval of manuscript.

Jeffrey Ponsky: study concept and design, critical appraisal of manuscript, final approval of manuscript.

Kevin El-Hayek: study concept and design, data collection, data analysis and interpretation, critical appraisal of manuscript, final approval of manuscript.

Corresponding author

Correspondence to Kevin El-Hayek.

Ethics declarations

As is customary at our institution for any novel interventional technique, all patients undergoing POP are tracked prospectively in a registry approved by the Institutional Review Board.

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Strong, A.T., Landreneau, J.P., Cline, M. et al. Per-Oral Pyloromyotomy (POP) for Medically Refractory Post-Surgical Gastroparesis. J Gastrointest Surg 23, 1095–1103 (2019). https://doi.org/10.1007/s11605-018-04088-7

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  • DOI: https://doi.org/10.1007/s11605-018-04088-7

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