Both gastric electrical stimulation and pyloric surgery offer long-term symptom improvement in patients with gastropares
- PDF / 1,289,866 Bytes
- 11 Pages / 595.276 x 790.866 pts Page_size
- 78 Downloads / 185 Views
and Other Interventional Techniques
2020 SAGES ORAL
Both gastric electrical stimulation and pyloric surgery offer long‑term symptom improvement in patients with gastroparesis Sarah Marowski1 · Yiwei Xu1 · Jake A. Greenberg1 · Luke M. Funk1,2 · Anne O. Lidor1 · Amber L. Shada1 Received: 23 April 2020 / Accepted: 27 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background 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. Methods 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. Results 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. Conclusions 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. Keywords Gastroparesis · Gastric stimulation · Pyloromyotomy · Pyloroplasty · GCSI
Introduction Gastroparesis is a disorder of gastric motility characterized by delayed gastric emptying in the absence of mechanical obstruction. This leads to nausea, vomiting, bloating, early * Amber L. Shada [email protected] 1
Department of Surgery, Madison School of Medicine and Public Health, University of Wisconsin, 600 Highland Ave, Madison, WI 53792, USA
Department of Surgery, University of Wisconsin-Madison; William S. Mid
Data Loading...
