Skip to main content
SpringerLink
Log in

The Long-Term Efficacy and Safety of Pyloroplasty Combined with Gastric Electrical Stimulation Therapy in Gastroparesis

  • 2016 SSAT Quick Shot Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

Gastroparesis is delayed gastric emptying without mechanical obstruction. Symptomatic improvement can be 50–60% with gastric electrical stimulation. To address delayed gastric emptying, pyloroplasty was added. This study examines the long-term efficacy and safety of simultaneous gastric electrical stimulator implantation and pyloroplasty.

Methods

In this prospective single-arm trial conducted from 2012 to 2015, 27 [23 females; mean age 43 (22–63)] gastroparesis patients who underwent simultaneous gastric electrical stimulator implantation with Heineke-Mikulicz pyloroplasty were studied. Six (25%) underwent simultaneous robot-assisted pyloroplasty and gastric electrical stimulator implantation. Diagnosis of gastroparesis was based on the 4-h gastric emptying test defined as >60% retention of isotope at 2 h and >10% at 4 h. Total symptom scores assessing severity of nausea, early satiety, bloating, vomiting, post-prandial fullness, and epigastric pain were obtained at baseline and at follow-up visits, ranging from 3 to 38 months (mean: 17).

Results

Follow-up data from 24 patients were available for analysis. There was 71% improvement in total symptom score on follow-up. Mean retention decreased by 29.6 and 48.7% at 2 and 4 h and gastric emptying was normalized in 60%. There were no post-surgical complications.

Conclusions

Combination of gastric electrical stimulator and pyloroplasty significantly accelerated gastric emptying and improved gastroparesis symptoms. Combining these two surgical therapies improves both subjective and objective endpoints in drug refractory gastroparesis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Parkman HP, Hasler WL, Fisher RS. American Gastroenterological Association technical review on the diagnosis and treatment of gastroparesis. Gastroenterology. 2004; 127:1592–622.

    Article  PubMed  Google Scholar 

  2. Wang YR, Fisher RS, Parkman HP. Gastroparesis-related hospitalizations in the United States: trends, characteristics, and outcomes 1995–2004. Am J Gastroenterol. 2008; 103:313–22.

    Article  PubMed  Google Scholar 

  3. Sarosiek I, Davis B, Eichler E, McCallum RW. Surgical approaches to treatment of gastroparesis: gastric electrical stimulation, pyloroplasty, total gastrectomy and enteral feeding tubes. Gastroenterol Clin N Am. 2015; 44:151–67.

    Article  Google Scholar 

  4. Abell TL, Camilleri M, Donohoe K, Hasler WL, Lin HC, Maurer AH, McCallum RW, Nowak T, Nusynowitz ML, Parkman HP, Shreve P, Szarka LA, Snape WJ Jr, Ziessman HA. Consensus recommendations for gastric emptying scintigraphy: a joint report of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine. J Nucl Med Technol. 2008; 36:44–54.

    Article  PubMed  Google Scholar 

  5. Parkman HP. Idiopathic gastroparesis. Gastroenerol Clin North Am. 2015; 44-59-68.

    Article  Google Scholar 

  6. Othman M, Davis B, Torabi A, Sarosiek R, McCallum RW. EUS-guided FNA biopsy of the muscularis propria of the antrum in patients with gastroparesis is feasible and safe. Gastrointest Endosc. 2016; 83(2): 327–33.

    Article  PubMed  Google Scholar 

  7. Moraveji S, Bashashati M, Elhanafi S, Sunny J, Sarosiek I, Davis B, Torabi A, McCallum RW. Depleted interstitial cells of Cajal and fibrosis in the pylorus: novel features of gastroparesis. Neurogastroenterol Motil. 2016; [Epub ahead of print].

  8. Borrazzo EC. Surgical management of gastroparesis: gastrostomy/jejunostomy tubes, gastrectomy, pyloroplasty, gastric electrical stimulation. J Gastrointest Surg. 2013; 17:1559–61.

    Article  PubMed  Google Scholar 

  9. McKenna D, Beverstein G, Reichelderfer M, Gaumnitz E, Gould J. Gastric electrical stimulation is an effective and safe treatment for medically refractory gastroparesis. Surgery. 2008; 144(4): 566–74.

    Article  PubMed  Google Scholar 

  10. Hibbard ML, Dunst CM, Swanstrom LL. Laparoscopic and endoscopic pyloroplasty for gastroparesis results in sustained symptoms improvement. J Gastrointest Surg. 2011; 15: 1513–19.

    Article  PubMed  Google Scholar 

  11. Reddymasu S. Sahilender S. Sankula R, Lavenbarg T, McCallum RW. Endoscopic pyloric injection of Botulinum Toxin A for the treatment of postvagotomy gastroparesis. Am J Med Sci. 2009; 337:161–4.

    Article  PubMed  Google Scholar 

  12. Sarosiek I, Forster J, Lin Z, Cherry S, Sarosiek J, McCallum R. The addition of pyloroplasty as a new surgical approach to enhance the effectiveness of gastric electrical stimulation therapy in patients with gastroparesis. Neurogastroenterol Motil. 2013; 25: 134-e80.

    Article  CAS  PubMed  Google Scholar 

  13. Abell TL, Van Cutsen E, Abrahamson H, Huizinga JD, Konturek JW, Galmiche JP, VoelIer G, Filez L, Everts B, Waterfall WE, Domschke W, Bruley des Varannes S, Familoni BO, Bourgeois IM, Janssens J, Tougas G. Gastric electrical stimulation in intractable symptomatic gastroparesis. Digestion. 2002; 66: 2014–12.

    Google Scholar 

  14. Abell T, McCallum R, Hocking M, Koch K, Abrahamsson H, Leblanc I, Lindberg G, Konturek J, Nowak T, Quigley EM, Tougas G, Starkebaum W. Gastric electrical stimulation for medically refractory gastroparesis. Gastroenterology. 2003; 125(2): 421–8.

    Article  PubMed  Google Scholar 

  15. McCallum RW, Snape W. Brody F, Wo J, Parkman PL. Gastric electrical stimulation with Enterra therapy improves symptoms from diabetic gastroparesis in a prospective study. Clin Gastroenterol Hepatol. 2010; 8:947–54.

    Article  PubMed  Google Scholar 

  16. Gould JC, Dholakia C. Robotic implantation of gastric electrical stimulation electrodes in gastroparesis. Surg Endosc. 2009; 23: 508–12.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to acknowledge Alex Rios-Tovar, MD, for his contribution to the literature search for manuscript preparation.

Author’s Contribution

Brian R. Davis: Substantial contributions to the conception or design of the work; drafting the work; final approval of the version to be published.

Irene Sarosiek: Substantial contributions to the conception or design of the work; revising it critically for important intellectual content; final approval of the version to be published.

Mohammad Bashashati: Analysis or interpretation of data for the work; revising it critically for important intellectual content; final approval of the version to be published.

Ben Alvarado: Acquisition, of data for the work; final approval of the version to be published.

Richard W. McCallum: Substantial contributions to the conception or design of the work; revising it critically for important intellectual content; final approval of the version to be published.

Author information

Authors and Affiliations

  1. Department of Surgery, Texas Tech University Health Sciences Center El Paso, 4800 Alberta Ave, El Paso, TX, 79905, USA

    Brian R. Davis

  2. Department of Internal Medicine, Division of Gastroenterology, Texas Tech University Health Sciences Center El Paso, 4800 Alberta Ave, El Paso, TX, 79905, USA

    Irene Sarosiek, Mohammad Bashashati, Ben Alvarado & Richard W. McCallum

Authors
  1. Brian R. Davis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Irene Sarosiek
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mohammad Bashashati
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ben Alvarado
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Richard W. McCallum
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Brian R. Davis.

Ethics declarations

Grant Support

Not applicable

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Davis, B.R., Sarosiek, I., Bashashati, M. et al. The Long-Term Efficacy and Safety of Pyloroplasty Combined with Gastric Electrical Stimulation Therapy in Gastroparesis. J Gastrointest Surg 21, 222–227 (2017). https://doi.org/10.1007/s11605-016-3327-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-016-3327-4

Keywords

Search

Navigation