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Laparoscopic and Endoscopic Pyloroplasty for Gastroparesis Results in Sustained Symptom Improvement

  • SSAT Poster Presentation
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Gastroparesis is a chronic digestive disorder with symptoms of nausea, vomiting, bloating, and abdominal pain resulting in a poor quality of life. Surgeons are increasingly asked to treat patients with gastroparesis as medical options have become limited due to safety concerns of many prokinetics. Surgical options include gastric stimulator implantation, sub-total gastrectomy, and pyloroplasty. We report our experience with minimally invasive pyloroplasty as sole surgical treatment for adult gastroparesis.

Materials and Methods

A retrospective review of prospectively collected data of 28 patients who underwent minimally invasive pyloroplasty alone as treatment for gastroparesis from Jan 2007 to Sept 2010. Pre- and postoperative symptom severity score (SSS), gastric emptying scintigraphy (GES), and medication use were reviewed.

Results

A laparoscopic Heineke–Mikulicz pyloroplasty was performed in 26 patients. A laparoscopic assisted, flexible trans-oral endoscopic circular stapled pyloroplasty was used in two patients. Prokinetic use was significantly reduced from 89% to 14% (p = <0.0001). The mean GES T1/2 decreased from 320 to 112 min (p = 0.001) and normalized in 71%. Significant improvements in the SSS were seen at 1 month for nausea (p = <0.0001), vomiting (p = <0.0001), bloating (p = 0.0023), abdominal pain (p = <0.0001), and gastroesophageal reflux disease (GERD) symptoms (p = 0.0143). Significant improvement persisted at 3 months for nausea (p = <0.0001), vomiting (p = <0.0001), bloating (p = 0.0004), abdominal pain (p = 0.0001) and GERD symptoms (p = 0.013). The average length of stay was 3.71 days. Overall, 83% of patients’ indicated that they saw improvement at 1 month follow-up.

Conclusion

Minimally invasive pyloroplasty provides excellent outcomes for patients with gastroparesis and should be considered as a primary treatment along with diet and medications as it is effective and does not eliminate the option for additional surgical options in the future for refractory disease. With technological advancements, a totally endoscopic pyloroplasty may be a less invasive option.

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References

  1. Perkel M, Moore C, Hersh T, Davidson E. Metoclopramide therapy in patients with delayed gastric emptying: a randomized, double-blind study. Dig Dis Sci 1979;24(9):662–6.

    Article  PubMed  CAS  Google Scholar 

  2. FDA Announces Discontinued Marketing of GI Drug, Zelnorm, for Safety Reasons. . In: Administration D, editor.2007.

  3. Tonini M, Cipollina L, Poluzzi E, Crema F, Corazza GR, De Ponti F. Review article: clinical implications of enteric and central D2 receptor blockade by antidopaminergic gastrointestinal prokinetics. . Aliment Pharmacol Ther. 2004;19(4):379–90.

    Article  PubMed  CAS  Google Scholar 

  4. Gheuens J. Propulsid (cisapride) Dear Healthcare Professional Letter. Janssen Pharmaceutica 2000.

  5. How to Obtain Domperidone. . In: Information FDA-DoD, editor.2008.

  6. Bromer MQ, Friedenberg F, Miller LS, Fisher RS, Swartz K, Parkman HP. Endoscopic pyloric injection of botulinum toxin A for the treatment of refractory gastroparesis. . Gastrointest Endosc 2005;61(7):833–9.

    Article  PubMed  Google Scholar 

  7. Ezzeddine D, Jit R, Katz N, Gopalswamy N, Bhutani MS. Pyloric injection of botulinum toxin for treatment of diabetic gastroparesis. . Gastrointest Endosc 2002;55(7):920–3.

    Article  PubMed  Google Scholar 

  8. Miller LS, Szych GA, Kantor SB, Bromer MQ, Knight LC, Maurer AH, et al. Treatment of idiopathic gastroparesis with injection of botulinum toxin into the pyloric sphincter muscle. Am J Gastroenterol 2002;97(7):1653–60.

    Article  PubMed  CAS  Google Scholar 

  9. Binswanger R, Aeberhard P, Walther M, Vock P. Effect of pyloroplasty on gastric emptying: long term results as obtained with a labelled test meal 14–43 months after operation. Br J Surg 1978;65(1):27–9.

    Article  PubMed  CAS  Google Scholar 

  10. Khajanchee YS, O’Rourke RW, Lockhart B, Patterson EJ, Hansen PD, Swanstrom LL. Postoperative symptoms and failure after antireflux surgery. Arch Surg. 2002 Sep;137(9):1008–13; discussion 13–4

    Article  PubMed  Google Scholar 

  11. Potter S, Spiro S, Nance F. An alternative method to traditional pyloroplasty using a circular stapler. J am coll surg. 1995;180(6):742–4.

    PubMed  CAS  Google Scholar 

  12. Søreide K, Sarr MG, Søreide JA. Pyloroplasty for benign gastric outlet obstruction—indications and techniques. . Scand J Surg 2006;95(1):11–6.

    PubMed  Google Scholar 

  13. Jones M, Maganti K. A systematic review of surgical therapy for gastroparesis. Am J Gastroenterol. 2003;98(10):2122–9.

    Article  PubMed  Google Scholar 

  14. Forstner-Barthell A, Murr M, Nitecki S, Camilleri M, Prather C, Kelly K, et al. Near-total completion gastrectomy for severe postvagotomy gastric stasis: analysis of early and long-term results in 62 patients. J Gastrointest Surg. 1999;3(1):15–21.

    Article  PubMed  CAS  Google Scholar 

  15. Reardon T, Schnell G, Smith O, Schubert T. Surgical Therapy for Gastroparesis. J Clin Gastroenterol. 1989;11(2):204–7.

    Article  PubMed  CAS  Google Scholar 

  16. McCallum R, Chen J, Lin Z, Schirmer B, Williams R, Ross R. Gastric pacing improves emptying and symptoms in patients with gastroparesis. . Gastroenterology. 1998;114(3):456–61.

    Article  PubMed  CAS  Google Scholar 

  17. Abell TL, Camilleri M, Donohoe K, Hasler WL, Lin HC, Maurer AH, et al. Consensus recommendations for gastric emptying scintigraphy: a joint report of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine. Am J Gastroenterol. 2008 Mar;103(3):753–63.

    Article  PubMed  Google Scholar 

  18. Abell T, Van Cutsem E, Abrahamsson H, Huizinga J, Konturek J, Galmiche J, et al. Gastric electrical stimulation in intractable symptomatic gastroparesis. Digestion. 2002;66(4):204–12.

    Article  PubMed  Google Scholar 

  19. Abell T, Bernstein R, Cutts T, Farrugia G, Forster J, Hasler W, et al. Treatment of gastroparesis: a multidisciplinary clinical review. Neurogastroenterol Motil. 2006;18(4):263–83.

    Article  PubMed  CAS  Google Scholar 

  20. Ayinala S, Batista O, Goyal A, Al-Juburi A, Abidi N, Familoni B, et al. Temporary gastric electrical stimulation with orally or PEG-placed electrodes in patients with drug refractory gastroparesis. Gastrointest Endosc 2005;61(3):455–61.

    Article  PubMed  Google Scholar 

  21. Gourcerol G, Leblanc I, Leroi AM, Denis P, Ducrotte P. Gastric electrical stimulation in medically refractory nausea and vomiting. European Journal of Gastroenterology and Hepatology. 2007;19:29–35.

    Article  PubMed  Google Scholar 

  22. Houghton L, Read N, Heddle R, Horowitz M, Collins P, Chatterton B, et al. Relationship of the motor activity of the antrum, pylorus, and duodenum to gastric emptying of a solid-liquid mixed meal. Gastroenterology. 1988;94(6):1285–91.

    PubMed  CAS  Google Scholar 

  23. Cullen J, Kelly K. Functional characteristics of canine pylorus in health, with pyloroplasty, and after pyloric reconstruction. Dig Dis Sci. 1996;41(4):711–9.

    Article  PubMed  CAS  Google Scholar 

  24. Rachlin L. Vagotomy and Heineke-Mikulicz pyloroplasty in the treatment of pyloric stenosis. Am Surg 1970;36(4):251–3.

    PubMed  CAS  Google Scholar 

  25. Johnson D. The past and present of antireflux surgery in children. Am J Surg. 2000;180(5):377–81.

    Article  PubMed  CAS  Google Scholar 

  26. Jawaid W, Abdalwahab A, Blair G, Skarsgard E, Webber E. Outcomes of pyloroplasty and pyloric dilatation in children diagnosed with nonobstructive delayed gastric emptying. J Pediatr Surg 2006;41(12):2059–61.

    Article  PubMed  Google Scholar 

  27. Danikas D, Geis W, Ginalis E, Gorcey S, Stratoulias C. Laparoscopic pyloroplasty in idiopathic hypertrophic pyloric stenosis in an adult. JSLS. 2000;4(2):173–5.

    PubMed  CAS  Google Scholar 

  28. Khajanchee YS, Dunst CM, Swanstrom LL. Outcomes of Nissen fundoplication in patients with gastroesophageal reflux disease and delayed gastric emptying. Arch Surg. 2009 Sep;144(9):823–8.

    Article  PubMed  Google Scholar 

  29. Masqusi S, Velanovich V. Pyloroplasty with fundoplication in the treatment of combined gastroesophageal reflux disease and bloating. World J Surg. 2007 Feb;31(2):332–6.

    Article  PubMed  Google Scholar 

  30. Davis C, Jellish W, Fisichella P. Laparoscopic fundoplication with or without pyloroplasty in patients with gastroesophageal reflux disease after lung transplantation: how I do it. J Gastrointest Surg. 2010; 14(9):1434–41.

    Article  PubMed  Google Scholar 

  31. Muensterer O, Adibe O, Harmon C, Chong A, Hansen E, Bartle D, et al. Single incision laparoscopic pyloromyotomy. Surg Endosc. 2009;24(7):1589–93.

    Article  PubMed  Google Scholar 

  32. Park P, Bergström M, Ikeda K, Fritscher-Ravens A, Mosse S, Kochman M, et al. Endoscopic pyloroplasty with full-thickness transgastric and transduodenal myotomy with sutured closure. Gastrointest Endosc. 2007;66(1):116–20.

    Article  PubMed  Google Scholar 

  33. Revicki D, Rentz A, Dubois D, Kahrilas P, Stanghellini V, Talley N, et al. Development and validation of a patient-assessed gastroparesis symptom severity measure: the Gastroparesis Cardinal Symptom Index. Aliment Pharmacol Ther. 2003;18(1):141–50.

    Article  PubMed  CAS  Google Scholar 

  34. Tougas G, Chen Y, Coates G, Paterson W, Dallaire C, Pare P, et al. Standardization of a simplified scintigraphic methodology for the assessment of gastric emptying in a multicenter setting. Am J Gastroenterol. 2000 Jan;95(1):78–86.

    Article  PubMed  CAS  Google Scholar 

  35. Mayo W. A Review of Five Hundred Cases of Gastro-Enterostomy, including Pyloroplasty, Gastroduodenostomy, and Gastrojejunostomy. Ann Surg 1905;42(5):641–55.

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Christy M. Dunst.

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Hibbard, M.L., Dunst, C.M. & Swanström, L.L. Laparoscopic and Endoscopic Pyloroplasty for Gastroparesis Results in Sustained Symptom Improvement. J Gastrointest Surg 15, 1513–1519 (2011). https://doi.org/10.1007/s11605-011-1607-6

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  • DOI: https://doi.org/10.1007/s11605-011-1607-6

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