Systematic review on sleeve gastrectomy or Roux-en-Y gastric bypass surgery for refractory gastroparesis

Metabolic and bariatric surgery outcomes in patients with gastroparesis: a retrospective analysis of the 2016 to 2022 Nationwide Readmissions Database

BACKGROUND

A subset of patients undergoing metabolic and bariatric surgery (MBS) for obesity treatment develop gastroparesis. It remains unclear how gastroparesis influences MBS outcomes.

METHODS

This study queried the 2016-2022 Nationwide Readmissions Database for patients aged ≥18 years with obesity who underwent sleeve gastrectomy or Roux-en-Y gastric bypass (RYGB). The primary outcomes were 30-day readmission, 30-day reoperation, length of stay (LOS), and discharge disposition. The secondary outcome was procedure type. This study investigated the unadjusted (using t tests, Kruskal-Wallis tests, and chi-square tests) and adjusted (using logistic regression) associations between gastroparesis status and outcomes.

RESULTS

Of 1,120,048 patients, 5738 (0.51%) had gastroparesis. Patients with gastroparesis were proportionally more likely to undergo RYGB than those without gastroparesis (65.6% vs 30.3%, respectively; P <.001). In addition, compared to patients without gastroparesis, those with gastroparesis had higher readmission rates (3.4% vs 7.7%, respectively; P <.001) and reoperation rates (1.0% vs 2.3%, respectively; P <.001) and were more likely to have longer LOS (median days: 1.0 vs 2.0, respectively; P <.001) and require home health services (1.8% vs 3.1%, respectively; P <.001). After adjusting for sociodemographic and clinical factors, patients with gastroparesis were 63.0% more likely to experience readmission (adjusted odds ratio [aOR], 1.64 [95% CI, 1.36-1.96]), 58.0% more likely to undergo reoperation (aOR, 1.58 [95% CI, 1.12-2.28]), and 75.4% more likely to stay >72 h in the hospital (aOR, 1.75 [95% CI, 1.46-2.11]).

CONCLUSION

MBS patients with gastroparesis more frequently undergo RYGB than the MBS population without gastroparesis. Patients with gastroparesis experience higher readmission and reoperation rates and are more likely to have a longer LOS. MBS teams should consider counseling patients about the risk of these postoperative events.

Current Concepts in Gastroparesis and Gastric Neuromuscular Disorders-Pathophysiology, Diagnosis, and Management

Upper gastrointestinal concerns including gastroparesis-like symptoms affect a large portion of the population, and determining the culprit condition can be difficult due to largely shared symptoms, clinical course, pathophysiology, and treatment pathways. The understanding of gastric neuromuscular disorders (GNDs) is emerging as a heterogeneous group encompassing conditions from gastroparesis to functional dyspepsia with chronic nausea, early satiety, bloating, or abdominal pain, irrespective of gastric emptying. This article aims to review the current concepts in gastroparesis and GNDs including pathophysiology, diagnosis, and management. While some established standards in their diagnosis and management exist, a number of novel diagnostics are becoming available. Durable therapeutic options are notably limited for such common conditions with chronic and debilitating symptoms, and neuromodulators may play a key role in symptom control, which has been previously under-recognized and underutilized. Advances in both pharmacologic treatment targets as well as noninvasive and invasive interventions and devices show promise in improving the experience of patients with gastroparesis-like symptoms. At this time, treatment of GNDs requires comprehensive multidisciplinary care from providers to achieve successful treatment outcomes.

Gastric schwannoma with post-surgical gastroparesis: a case report and literature review

Gastric schwannoma is a relatively rare submucosal mesenchymal tumor with low probability of metastasis and arises from Schwann cells of the gastrointestinal nervous plexus. Surgical therapy is the main treatment of gastric schwannoma with symptoms or malignant tendency. Gastroparesis is a potential complication following gastrointestinal surgery, which is a clinical syndrome caused by gastric emptying disorder and characterized by nausea, vomiting, and bloating, resulting in insufficient nutrient intake. Generally, post-surgical etiology is the main potential etiology of gastroparesis, while the most common underlying etiology is diabetes mellitus. So far, reports of gastroparesis arising from resection of gastric schwannoma are rare. We present an 80-year-old woman who was diagnosed with gastrointestinal stromal tumor (GIST) primarily and has undergone laparoscopic wedge-shaped gastrectomy. The pathological and immunohistochemical examination ultimately established the diagnosis of gastric schwannoma. The patient experienced belching, nausea, vomiting, and bloating 1 week after the surgery and confirmed as gastroparesis through gastrointestinal series and gastroscopic examination. A series of treatments were performed, including correcting fluid-electrolyte disorders and vitamin deficiencies, and nutritional support and pharmacological treatments. The patient ultimately recovered well, and the relevant literatures were reviewed to identify and handle similar cases hereafter.

Nutritional aspects in patients with gastroparesis

PURPOSE OF REVIEW

The purpose of this review was to highlight most recent updates on nutritional aspects in gastroparesis (GP) focusing on dietary recommendations, utilization of enteral and parenteral nutrition, endoscopic and surgical interventions.

RECENT FINDINGS

Recent data addressed eating patterns, nutritional interventions, and clarifications on the role of endoscopic and surgical interventions underlying an impact on nutritional management of GP patients. They support the importance of gastroparesis-specific diet in addition to drug therapy, and confirm the benefits of a modified low-fat, low-fiber diet. Current guidelines suggest a new approach to GP management based on predominant symptoms. Gastric peroral endoscopic pyloromyotomy (G-POEM) and surgical gastric electrical stimulator (GES) placement may be considered in individuals with nausea and vomiting before the need for jejunostomy tube placement for enteral feeding or parenteral nutrition.

SUMMARY

Current literature supports the importance of dietary interventions, focusing on low-fat and low-fiber diets, in addition to drug therapies. Severely fiber-restrictive diets may not be necessary. There is enhanced understanding when jejunal feeding should be incorporated for refractory cases with consideration of G-POEM or/and GES even before jejunal tube placement. This approach will require patient evaluation in specialized motility centers.

Gut motility and hormone changes after bariatric procedures

PURPOSE OF REVIEW

Metabolic and bariatric surgery (MBS) and endoscopic bariatric therapies (EBT) are being increasingly utilized for the management of obesity. They work through multiple mechanisms, including restriction, malabsorption, and changes in the gastrointestinal hormonal and motility.

RECENT FINDINGS

Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) cause decrease in leptin, increase in GLP-1 and PYY, and variable changes in ghrelin (generally thought to decrease). RYGB and LSG lead to rapid gastric emptying, increase in small bowel motility, and possible decrease in colonic motility. Endoscopic sleeve gastroplasty (ESG) causes decrease in leptin and increase in GLP-1, ghrelin, and PYY; and delayed gastric motility.

SUMMARY

Understanding mechanisms of action for MBS and EBT is critical for optimal care of patients and will help in further refinement of these interventions.

Pathogenesis and management of diabetic gastroparesis: An updated clinically oriented review

BACKGROUND AND AIMS

Diabetic gastroparesis (DGp) is a common and preventable complication of uncontrolled diabetes mellitus (D.M.) and significantly affects the Quality of Life of patients. Diagnosis and management present as a clinical challenge due to the disease's complexity and limited effective therapeutic options. This review aims to comprehensively outline the pathogenesis, diagnosis, and management of diabetic gastroparesis, evaluating evolving approaches to guide clinicians and provide future recommendations.

METHODS

A literature review was conducted on scholarly databases of PubMed, Google Scholar, Scopus and Web of Science encompassing published articles, gray literature and relevant clinical guidelines. Data were synthesized and analyzed to provide a comprehensive overview of diabetic gastroparesis, focusing on pathogenesis, diagnosis, and management.

RESULTS

The review intricately explores the pathogenesis contributing to diabetic gastroparesis, emphasizing autonomic neuropathy, oxidative stress, inflammation, hormonal dysregulation, microbiota alterations, and gastrointestinal neuropathy. Primary management strategies are underscored, including lifestyle modifications, symptom relief, and glycemic control. The discussion encompasses pharmacological and surgical options, highlighting the importance of a multidisciplinary approach involving various healthcare professionals for comprehensive patient care.

CONCLUSION

This review offers a thorough understanding of pathogenesis, diagnosis, and management of diabetic gastroparesis, underlining evolving approaches for clinicians. A multidisciplinary approach is crucial to address both the physical and mental health aspects of diabetes and its complications.