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Endoscopic Management: Interventions at the Pylorus

  • Andrew T. Strong
  • Matthew D. KrohEmail author
Chapter

Abstract

Gastroparesis is a functional disorder of the stomach defined by delayed gastric emptying, in the absence of mechanical obstruction. Classically subdivided into diabetes associated, postsurgical, medication induced, and idiopathic, gastroparesis produces persistent nausea, vomiting, early satiety, bloating, and abdominal pain. The mainstays of therapy are dietary modification, as well as prokinetic and antiemetic medications. However, the progressive nature of gastroparesis in many patients suggests that medically nonresponsive gastroparesis may eventually develop. An array of surgical options exist, but recent endoscopic advances have made the pylorus a therapeutic target to improve gastric emptying. Here reviewed is the anatomic structure and physiologic function of the pylorus. Evidence for endoscopic interventions including balloon dilation of the pylorus, transpyloric stenting, injection of botulinum toxin at the pylorus, and an emerging therapy within the realm of intramural surgery-peroral endoscopic myotomy (POP) are reviewed.

Keywords

Gastroparesis Pylorus Endoscopy balloon dilation Pneumatic dilation Hydraulic dilation Transpyloric stent Botulinum toxin Peroral endoscopic myotomy (POP) Intramural surgery 

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Copyright information

© SAGES 2019

Authors and Affiliations

  1. 1.Department of General SurgeryCleveland ClinicClevelandUSA
  2. 2.Digestive Disease Institute, Cleveland Clinic Lerner College of Medicine, Department of General Surgery, Cleveland ClinicAbu DhabiUnited Arab Emirates

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