Andrew T Strong1,2, Joshua P Landreneau1,2, Michael Cline2,3, Matthew D Kroh1,2,4, John H Rodriguez1,2, Jeffrey L Ponsky1,2, Kevin El-Hayek5,6. 1. Department of General Surgery, Cleveland Clinic, Desk A-100, 9500 Euclid Avenue, Cleveland, OH, 44195, USA. 2. Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA. 3. Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA. 4. Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates. 5. Department of General Surgery, Cleveland Clinic, Desk A-100, 9500 Euclid Avenue, Cleveland, OH, 44195, USA. elhayek@ccf.org. 6. Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA. elhayek@ccf.org.
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.
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.
Authors: T M Farrell; W S Richardson; R Halkar; C P Lyon; K D Galloway; J P Waring; C D Smith; J G Hunter Journal: Surg Endosc Date: 2001-02-06 Impact factor: 4.584
Authors: James D Luketich; Hiran C Fernando; Neil A Christie; Percival O Buenaventura; Sayeed Ikramuddin; Philip R Schauer Journal: Ann Thorac Surg Date: 2002-08 Impact factor: 4.330
Authors: D A Revicki; A M Rentz; D Dubois; P Kahrilas; V Stanghellini; N J Talley; J Tack Journal: Aliment Pharmacol Ther Date: 2003-07-01 Impact factor: 8.171
Authors: Dennis A Revicki; Anne M Rentz; Dominique Dubois; Peter Kahrilas; Vincenzo Stanghellini; Nicholas J Talley; Jan Tack Journal: Qual Life Res Date: 2004-05 Impact factor: 4.147
Authors: A W Forstner-Barthell; M M Murr; S Nitecki; M Camilleri; C M Prather; K A Kelly; M G Sarr Journal: J Gastrointest Surg Date: 1999 Jan-Feb Impact factor: 3.267
Authors: Joshua P Landreneau; Andrew T Strong; Kevin El-Hayek; Matthew D Kroh; John H Rodriguez Journal: Surg Endosc Date: 2019-07-11 Impact factor: 4.584
Authors: Michael Camilleri; Braden Kuo; Linda Nguyen; Vida M Vaughn; Jessica Petrey; Katarina Greer; Rena Yadlapati; Thomas L Abell Journal: Am J Gastroenterol Date: 2022-06-03 Impact factor: 12.045
Authors: Sarah Marowski; Yiwei Xu; Jake A Greenberg; Luke M Funk; Anne O Lidor; Amber L Shada Journal: Surg Endosc Date: 2020-10-06 Impact factor: 4.584
Authors: Maria Chiara Verga; Stefano Mazza; Francesco Azzolini; Fabrizio Cereatti; Clara Benedetta Conti; Andrea Drago; Sara Soro; Biagio Elvo; Roberto Grassia Journal: World J Gastrointest Surg Date: 2022-01-27