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Surgical Treatment for Refractory Gastroparesis: Stimulator, Pyloric Surgery, or Both?

  • Bryan Zoll
  • Asad Jehangir
  • Michael A. Edwards
  • Roman Petrov
  • William Hughes
  • Zubair Malik
  • Henry P. ParkmanEmail author
Original Article
  • 8 Downloads

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 

Notes

Authors Contributions

Bryan Zoll, MD, MBA: data acquisition, data interpretation, drafting and revising manuscript.

Asad Jehangir, MD: data acquisition, data interpretation, drafting and revising manuscript.

Michael A. Edwards, MD: study concept, surgical procedures, revising manuscript.

Roman Petrov, MD, PhD: surgical procedures, revising manuscript.

William Hughes, MD: surgical procedures, revising manuscript.

Zubair Malik, MD: drafting and revising manuscript.

Henry P. Parkman, MD: study concept, patient enrollment, drafting and revising manuscript.

Compliance with Ethical Standards

Enterra gastric electric stimulator (GES) for refractory gastroparesis is approved under the FDA humanitarian device exemption program and approved at our institution by our Institutional Review Board

Conflicts of Interest

The authors declare that they have no conflict of interest.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  • Bryan Zoll
    • 1
  • Asad Jehangir
    • 1
  • Michael A. Edwards
    • 2
  • Roman Petrov
    • 3
  • William Hughes
    • 1
  • Zubair Malik
    • 1
  • Henry P. Parkman
    • 1
    Email author
  1. 1.Section of Gastroenterology, Department of MedicineLewis Katz School of Medicine at Temple UniversityPhiladelphiaUSA
  2. 2.Department of General SurgeryMayo ClinicJacksonvilleUSA
  3. 3.Department of Thoracic Medicine and SurgeryLewis Katz School of Medicine at Temple UniversityPhiladelphiaUSA

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