Gastroparesis (GP) is hallmarked by nausea, vomiting, and early satiety. While dietary and medical therapy are the mainstay of treatment, surgery has been used to palliate symptoms. Two established first-line surgical options are gastric electrostimulation (GES) and pyloric procedures (PP) including pyloroplasty or pyloromyotomy. We sought to compare these modalities’ improvement in Gastroparesis cardinal symptom index (GCSI) subscores and potential predictors of therapy failure.
All patients undergoing surgery at a single institution were prospectively identified and separated by surgery: GES, PP, or combined GESPP. GCSI was collected preoperatively, at 6 weeks and 1 year. Postoperative GCSI score over 2.5 or receipt of another gastroparesis operation were considered treatment failures. Groups were compared using Pearson’s chi-squared and Kruskal–Wallis one-way ANOVA.
Eighty-two patients were included: 18 GES, 51 PP, and 13 GESPP. Mean age was 44, BMI was 26.7, and 80% were female. Preoperative GCSI was 3.7. The PP group was older with more postsurgical gastroparesis. More patients with diabetes underwent GESPP. Preoperative symptom scores and gastric emptying were similar among all groups. All surgical therapies resulted in a significantly improved GCSI and nausea/vomiting subscore at 6 weeks and 1 year. Bloating improved initially, but relapsed in the GES and GESPP group. Satiety improved initially, but relapsed in the PP group. Fifty-nine (72%) had surgical success. Ten underwent additional surgery (7 crossed into the GESPP group, 3 underwent gastric resection). Treatment failures had higher preoperative GCSI, bloating, and satiety scores. Treatment failures and successes had similar preoperative gastric emptying.
Both gastric electrical stimulation and pyloric surgery are successful gastroparesis treatments, with durable improvement in nausea and vomiting. Choice of operation should be guided by patient characteristics and discussion of surgical risks and benefits. Combination GESPP does not appear to confer an advantage over GES or PP alone.
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Effort on this study and manuscript was made possible by a George H.A. Clowes, Jr., MD, FACS, Memorial Research Career Development Award from the American College of Surgeons and a VA Career Development Award (CDA 015–060) to Dr. Luke Funk. The views represented in this article represent those of the authors and not those of the DVA or the US Government.
Dr. Amber Shada has provided surgeon education for Medtronic for the Enterra Gastric Electrical Stimulation device. Effort on this study and manuscript was made possible by a George H.A. Clowes, Jr., MD, FACS, Memorial Research Career Development Award from the American College of Surgeons and a VA Career Development Award (CDA 015-060) to Dr. Luke Funk. The views represented in this article represent those of the authors and not those of the DVA or the US Government. Sara Marowski, Yiwei Xu, as well as Drs. Anne O. Lidor, and Jacob A. Greenberg have no conflicts of interest or financial ties to disclose.
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Marowski, S., Xu, Y., Greenberg, J.A. et al. Both gastric electrical stimulation and pyloric surgery offer long-term symptom improvement in patients with gastroparesis. Surg Endosc 35, 4794–4804 (2021). https://doi.org/10.1007/s00464-020-07960-3
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