Surgical Treatment for Refractory Gastroparesis: Stimulator, Pyloric Surgery, or Both?
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ORIGINAL ARTICLE
Surgical Treatment for Refractory Gastroparesis: Stimulator, Pyloric Surgery, or Both? Bryan Zoll 1 & Asad Jehangir 1 & Michael A. Edwards 2 & Roman Petrov 3 & William Hughes 1 & Zubair Malik 1 & Henry P. Parkman 1 Received: 8 June 2019 / Accepted: 28 August 2019 # 2019 The Society for Surgery of the Alimentary Tract
Abstract Background Several surgical options exist for refractory gastroparesis (Gp) including gastric electric stimulation (GES) and pyloric surgery (PS) such as pyloromyotomy or pyloroplasty. Few studies exist comparing the outcomes of these surgeries. Aim Compare the clinical outcomes of GES, PS, and simultaneous GES+PS for refractory Gp. Methods Patients undergoing surgical intervention at our medical center from January 2016 to April 2019 were given pre- and post-surgery questionnaires to assess their response to intervention: Patient Assessment of Upper Gastrointestinal Symptoms (PAGI-SYM) grading symptoms and Clinical Patient Grading Assessment Scale (CPGAS) grading response to treatment. Results are expressed as mean ± SE. Results One hundred thirty-two patients underwent surgical intervention; 12 were excluded. Mean CPGAS improvement overall was 2.8 ± 0.2 (p < 0.01): GES+PS had CPGAS score at 3.6 ± 0.5, pyloric interventions 3.1 ± 0.5, and GES 2.5 ± 0.4 (p > 0.05). Mean improvement in Gastroparesis Cardinal Symptom Index (GCSI) total score was 1.0 ± 0.1 (p < 0.01), with improvement of 1.1 ± 0.2 for GES + PS, 0.9 ± 0.2 for GES, and 0.9 ± 0.2 for PS (p > 0.05). GES and GES + PS, but not PS only, significantly improved symptoms of nausea and vomiting (p < 0.01). Among gastroparesis subtypes, patients with diabetic gastroparesis had more improvement on nausea/vomiting subscale compared with idiopathic gastroparesis (p = 0.028). Conclusions Patients with refractory symptoms of Gp undergoing GES, PS, or combined GES+PS each had significant improvement of their GCSI total score. GES and combined GES+PS significantly improved nausea/vomiting. These results suggest GES or combined GES+PS appears better for nausea/vomiting predominant refractory Gp. Keywords Gastroparesis . Gastric electric stimulation . Pyloroplasty . Pyloromyotomy
Introduction Gastroparesis (Gp) is a chronic gastrointestinal motility disorder of delayed gastric emptying with associated symptoms of nausea, vomiting, early satiety, postprandial fullness, and abdominal pain.1 Gp is divided into three main subcategories: * Henry P. Parkman [email protected] 1
Section of Gastroenterology, Department of Medicine, Lewis Katz School of Medicine at Temple University, 3401 North Broad Street, Philadelphia, PA 19140, USA
2
Department of General Surgery, Mayo Clinic, Jacksonville, FL, USA
3
Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
diabetic, idiopathic, and post-surgical. The frequently intractable symptoms of gastroparesis make it a difficult disease to treat. Many patients do not respond to conventional medical treatments including diet
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