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Gonzalez JM, Mion F, Pioche M, Garbay V, Baumstarck K, Boucekine M, Debourdeau A, Rivory J, Barthet M, Vitton V. Gastric peroral endoscopic myotomy versus botulinum toxin injection for the treatment of refractory gastroparesis: results of a double-blind randomized controlled study. Endoscopy 2024; 56:345-352. [PMID: 38141620 DOI: 10.1055/a-2235-3286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2023]
Abstract
INTRODUCTION Gastric peroral endoscopic myotomy (G-POEM) is a promising technique for treating refractory gastroparesis. We present the first double-blind randomized study comparing the clinical efficacy of G-POEM versus pyloric botulinum toxin injection (BTI). METHODS This randomized study, conducted in two expert centers, enrolled patients with refractory gastroparesis, medically managed for >6 months and confirmed by gastric emptying scintigraphy (GES), into two groups, G-POEM versus BTI, with follow-up of 1 year. The primary end point was the 3-month clinical efficacy, defined as a >1-point decrease in the mean Gastroparesis Cardinal Symptom Index (GCSI) score. Secondary end points were: 1-year efficacy, GES evolution, adverse events, and quality of life. RESULTS 40 patients (22 women; mean age 48.1 [SD 17.4]), with mean symptom duration of 5.8 (SD 5.7) years, were randomized. Etiologies included idiopathic (n=18), diabetes (n=11), postoperative (n=6), and mixed (n=4). G-POEM showed a higher 3-month clinical success than BTI (65% vs. 40%, respectively; P=0.10), along with non-significantly higher 1-year clinical success (60% vs. 40%, respectively) on intention-to-treat analysis. The GCSI decreased in both groups at 3 months and 1 year. Only three minor adverse events occurred in the G-POEM group. The GES improvement rate was 72% in the G-POEM group versus 50% in the BTI group (non-significant). CONCLUSION G-POEM seems to have a higher clinically relevant success rate than BTI, but this was not statistically demonstrated. This study confirms the interest in treatments targeting the pylorus, either mechanically or chemically, for managing refractory gastroparesis.
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Affiliation(s)
| | | | - Mathieu Pioche
- Endoscopy Unit, Digestive Disease Department, Hôpital Edouard Herriot, Lyon, France
| | - Victor Garbay
- Hôpital Nord, Gastroenterology, AP-HM, Marseille, France
| | - Karine Baumstarck
- Public Health, Aix-Marseille Université Faculté de Medecine, Marseille, France
| | - Mohamed Boucekine
- Public Health, Aix-Marseille Université Faculté de Medecine, Marseille, France
| | | | - Jérôme Rivory
- Endoscopy Unit, Digestive Disease Department, Hôpital Edouard Herriot, Lyon, France
| | - Marc Barthet
- Hôpital Nord, Gastroenterology, AP-HM, Marseille, France
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Zhu C, Da M, Ma J, Li Y. Risk factors for gastroparesis syndrome after radical gastric cancer surgery. Asian J Surg 2024; 47:1974-1975. [PMID: 38218638 DOI: 10.1016/j.asjsur.2023.12.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 12/29/2023] [Indexed: 01/15/2024] Open
Affiliation(s)
- Ciba Zhu
- The First Clinical Medicine College, Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, China
| | - Mingxu Da
- The First Clinical Medicine College, Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, China; Department of Oncology Surgery, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Jichun Ma
- The First Clinical Medicine College, Lanzhou University, Lanzhou, 730000, China
| | - Yaoqi Li
- Department of Oncology Surgery, Gansu Provincial Hospital, Lanzhou, 730000, China.
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Pather K, Mobley EM, Awad ZT. Utility of gastrostomy tube placement at the time of pancreaticoduodenectomy. Surg Endosc 2024; 38:2205-2211. [PMID: 38448619 DOI: 10.1007/s00464-024-10735-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 01/28/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE The aim of this study is to investigate the utility of gastrostomy tube (G-tube) placement in reducing delayed gastric emptying (DGE) among patients undergoing pancreaticoduodenectomy (PD). METHODS We retrospectively reviewed consecutive patients undergoing PD from 2015 to 2020 at our institution. Thirty-day patient outcomes including DGE, length of stay (LOS), reoperation rates, and morbidity were analyzed in patients with or without G-tube placement. RESULTS 128 patients with resectable pancreatic head cancer (54 females, median age 68.50 [59.00-74.00]) underwent PD (66 had G-tube placement and 62 did not). There was no significant difference in the incidence of DGE (n = 17 vs. n = 17, p = 0.612), and LOS between the groups. Postoperative ileus (p = 0.007) was significantly lower while atrial fibrillation (p = 0.037) was higher among the G-tube group. Gastrostomy-related complications (p = 0.001) developed in ten patients: skin-related complications (n = 6), tube dislodgement (n = 3) and clogging (n = 1). Nine patients required reoperation during index admission (n = 4 vs. n = 5, p = 1.000). There was no difference in 30-day readmissions (n = 7 vs. n = 5, p = 0.471) and no difference in 30 or 90-day mortality. CONCLUSION Gastrostomy tube placement during index PD did not affect the incidence of DGE. However, patients experienced significant morbidities due to G-tube-related complications. Placement of gastrostomy tubes at the index PD offers no clinical benefits.
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Affiliation(s)
- Keouna Pather
- Department of Surgery, University of Florida College of Medicine-Jacksonville, 655 W. 8th Street, Jacksonville, FL, 32209, USA
| | - Erin M Mobley
- Department of Surgery, University of Florida College of Medicine-Jacksonville, 655 W. 8th Street, Jacksonville, FL, 32209, USA
| | - Ziad T Awad
- Department of Surgery, University of Florida College of Medicine-Jacksonville, 655 W. 8th Street, Jacksonville, FL, 32209, USA.
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Uzun E, d'Amore A, Berlth F, Mann C, Tagkalos E, Hadzijusufovic E, Lang H, Grimminger PP. Anterior gastric wall anastomosis may lead to lower rate of delayed gastric emptying after minimally invasive Ivor Lewis esophagectomy: a retrospective cohort study. Surg Endosc 2024; 38:1950-1957. [PMID: 38334779 PMCID: PMC10978725 DOI: 10.1007/s00464-024-10696-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 01/08/2024] [Indexed: 02/10/2024]
Abstract
INTRODUCTION In minimally invasive esophagectomy, a circular stapled anastomosis is common, but no evidence exists investigating the role of the specific localization of the anastomosis. The aim of this study is to evaluate the impact of an esophagogastrostomy on the anterior or posterior wall of the gastric conduit on the postoperative outcomes. MATERIAL AND METHODS All oncologic minimally invasive Ivor Lewis procedures, performed between 2017 and 2022, were included in this study. The cohort was divided in two groups: a) intrathoracic esophagogastrostomy on the anterior gastric wall of the conduit (ANT, n = 285, 65%) and b) on the posterior gastric wall (POST, n = 154, 35%). Clinicopathological parameters and short-term outcomes were compared between both groups by retrieving data from the prospective database. RESULTS Overall, 439 patients were included, baseline characteristics were similar in both groups, there was a higher proportion of squamous cell carcinoma in ANT (22.8% vs. 16.2%, P = 0.043). A higher rate of robotic-assisted procedures was observed in ANT (71.2% vs. 49.4%). Anastomotic leakage rate was similar in both groups (ANT 10.4% vs. POST 9.8%, P = 0.851). Overall complication rate and Clavien-Dindo > 3 complication rates were higher in POST compared to ANT: 53.2% vs. 40% (P = 0.008) and 36.9% vs. 25.7% (P = 0.014), respectively. The rate of delayed gastric emptying (20.1% vs. 7.4%, P < 0.001) and nosocomial pneumonia (22.1% vs. 14.8%, P = 0.05) was significantly higher in POST. CONCLUSION Patients undergoing minimally invasive Ivor Lewis esophagectomy with an intrathoracic circular stapled anastomosis may benefit from esophagogastrostomy on the anterior wall of the gastric conduit, in terms of lower rate of delayed gastric emptying.
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Affiliation(s)
- Eren Uzun
- Department of General-, Visceral- and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Alberto d'Amore
- Department of General-, Visceral- and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Felix Berlth
- Department of General-, Visceral- and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Carolina Mann
- Department of General-, Visceral- and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Evangelos Tagkalos
- Department of General-, Visceral- and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Edin Hadzijusufovic
- Department of General-, Visceral- and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Hauke Lang
- Department of General-, Visceral- and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Peter Philipp Grimminger
- Department of General-, Visceral- and Transplant Surgery, University Medical Center of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany.
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Shyr BS, Shyr YM, Chen SC, Wang SE, Shyr BU. Reappraisal of surgical and survival outcomes of 500 consecutive cases of robotic pancreaticoduodenectomy. J Hepatobiliary Pancreat Sci 2024; 31:99-109. [PMID: 37881144 DOI: 10.1002/jhbp.1383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
BACKGROUND The role of the robotic approach for pancreaticoduodenectomy has not been well established with robust data. This study aimed to reappraise feasibility and justification of robotic pancreaticoduodenectomy (RPD) over time. METHODS A total of 500 patients undergoing RPD were enrolled and divided into early (first 250 patients) and late (last 250 patients) groups for a comparative study. RESULTS The conversion rate was 8.8% overall and was significantly lower in the late group (5.6% vs. 12.0%; p = .012). The overall median intraoperative blood loss was 130 mL. Radicality of resection was similar between early and late groups. The overall surgical mortality after RPD was 1.3%. The overall surgical morbidity and major complication was 44.1% and 13.2%, respectively, and similar between early and late groups. Chyle leakage was the most common complication after RPD (25.0%), followed by postoperative pancreatic fistula (POPF). The POPF rate was 8.6% overall, with 5.9% in the early group and 11.0% in the late group, p = .051. The overall delayed gastric emptying rate was 3.5%. The late group had better survival outcomes than those of the early group after RPD for ampullary adenocarcinoma (p = .027) but not for pancreatic head adenocarcinoma. CONCLUSIONS Reappraisal of this study has confirmed that RPD is not only technically feasible without increasing surgical risks but also oncologically justified without compromising survival outcomes for both pancreatic head and other periampullary cancers over time. Moreover, RPD is associated with the benefits of low surgical mortality, blood loss, and delayed gastric emptying.
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Affiliation(s)
- Bor-Shiuan Shyr
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yi-Ming Shyr
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Shih-Chin Chen
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Shin-E Wang
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Bor-Uei Shyr
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Drury AM, Albunni H, Al-Haddad M, Powelson JA, Lutz A, Fridell JA. Role of gastric peroral endoscopic myotomy (GPOEM) in chronic gastroparesis management after pancreas transplantation. Clin Transplant 2024; 38:e15176. [PMID: 37922244 DOI: 10.1111/ctr.15176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/11/2023] [Accepted: 10/20/2023] [Indexed: 11/05/2023]
Abstract
Gastroparesis is a common complaint among patients with diabetes. Symptoms tend to improve following successful pancreas transplantation (PTx), but persist despite euglycemia in a subset of patients. We aimed to assess the benefit of gastric peroral endoscopic myotomy (G-POEM) in persistent gastroparesis following PTx. This was a single center retrospective review of all patients who underwent G-POEM for persistent gastroparesis following PTx. Patient demographics, pre and post procedure perception of symptom severity according to the patient assessment of upper gastrointestinal symptoms severity index (PAGI-SYM), gastroparesis cardinal symptom index (GCSI) score, and 36-item short form survey (SF36) score along with gastric emptying scintigraphy (GES) were analyzed. Seven PTx recipients underwent G-POEM for persistent gastroparesis symptoms. The majority were female. All reported nausea/vomiting, abdominal pain, bloating, and post prandial fullness prior to G-POEM. The post procedure survey scores improved in all patients although this was not significant. The improvement in gastric emptying on GES was statistically significant. G-POEM is a relatively new treatment option for gastroparesis. While it requires specialized proceduralist and training, we have documented improvement in the management of symptoms. With increasing experience, we anticipate more significant benefit in post PTx patients with persistent symptoms of gastroparesis undergoing G-POEM.
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Affiliation(s)
- Allison M Drury
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Hashem Albunni
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Mohammad Al-Haddad
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - John A Powelson
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Andrew Lutz
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jonathan A Fridell
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Davis G, Liu L, Bernardi K, Saad AR, Sujka J, Velanovich V. Health services utilization of patients with gastroparesis treated with gastric neurostimulation with and without concomitant pyloroplasty or subsequent pyloromyotomy. J Gastrointest Surg 2024; 28:75-76. [PMID: 38353079 DOI: 10.1016/j.gassur.2023.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 02/16/2024]
Affiliation(s)
- Graham Davis
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, United States
| | - Langfeier Liu
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, United States
| | - Karla Bernardi
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, United States
| | - Adham R Saad
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, United States
| | - Joseph Sujka
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, United States
| | - Vic Velanovich
- Division of Gastrointestinal Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, United States.
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Docimo S, Thélin C, Sujka JA. Surgical Treatment of Gastroparesis. J Vis Exp 2023. [PMID: 38108395 DOI: 10.3791/65564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Gastroparesis and intestinal dysmotility are life-altering diagnoses with no cure. Lifestyle changes, pharmacological, and surgical interventions are combined in a multidisciplinary fashion to improve the quality of life in this patient population. Starting with lifestyle changes, adjustments are made to the types and amounts of food consumed, medical conditions are optimized, and the use of narcotic pain medications as well as smoking is discontinued. For many, these changes are not enough, and antiemetics and promotility agents are used to control symptoms. Finally, when these measures fail, patients turn to surgery, which can include surgical alterations to the stomach, implantation of a gastric stimulator, placement of drainage tubes, and possibly even the complete removal of different organs, including the stomach or gallbladder. In our clinic, patients not only see a surgeon but also a gastroenterologist, dietitian, and psychologist. We strongly believe in a multidisciplinary approach to this condition. The goal is to provide patients with hope and help them live fuller and happier lives. The study primarily addresses technical considerations and the surgical approach for patients diagnosed with gastroparesis. It outlines the entire process, starting from preparations before the surgery, encompassing the preoperative work-up, and detailing the steps involved in the surgical procedure. One of the key diagnostic challenges faced in treating gastroparesis patients is determining the underlying cause of the condition, as this information is critical for selecting the appropriate surgical intervention. Once the patient's condition has been categorized based on the cause, the medical team engages in a discussion with the patient regarding potential treatment options, which may include endoscopic procedures, minimally invasive techniques, or open surgery.
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Affiliation(s)
| | - Camile Thélin
- Camille Department of GI Medicine, University of South Florida
| | - Joseph Adam Sujka
- Salvatore Department of Surgery, University of South Florida; Camille Department of GI Medicine, University of South Florida; Department of Surgery, University of South Florida;
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Martín S, Secanella L, Sorribas M, Peláez N, Salord S, Lopez-Urdiales R, Fabregat J, Busquets J. Study of risk factors for delayed gastric emptying after partial pancretoduodenectomy. Cir Esp 2023; 101:657-664. [PMID: 36716958 DOI: 10.1016/j.cireng.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 09/21/2022] [Accepted: 10/30/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Delayed gastric emptying is one of the most frequent complications after pancreatoduodenectomy. METHODS We performed an analysis of risk factors for delayed gastric emptying on a prospective database of 390 patients operated on between 2013 and 2021. A comparative retrospective study was carried out between patients with and without delayed gastric emptying and subsequently a study of risk factors for delayed gastric emptying using univariate and multivariate logistic regression models. RESULTS The incidence of delayed gastric emptying in the overall series was 28%. The morbidity of the group was 63%, and postoperative mortality was 3.1%. Focusing on delayed gastric emptying, the median age (73 years vs 68 years, P < 0.001) and preoperative creatinine (75 vs 65.5, P < 0.001) were higher in the group with this complication. The study of risk factors showed that age over 60 years (P = 0.002) and pancreatic fistula (P < 0.001) were risk factors for delayed gastric emptying. CONCLUSION The presence of pancreatic fistula is confirmed as a risk factor for slow gastric emptying after pancreaticoduodenectomy. In addition, age over 60 years is shown to be a risk factor for slow gastric emptying.
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Affiliation(s)
- S Martín
- General and Digestive Surgery Service, Viladecans Hospital, Viladecans, Spain
| | - Ll Secanella
- Department of Hepatobiliary and Pancreatic Surgery, Bellvitge University Hospital, Research Group of Hepato-biliary and Pancreatic Diseases, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, University of Barcelona L'Hospitalet de Llobregat, Barcelona, Spain
| | - M Sorribas
- Department of Hepatobiliary and Pancreatic Surgery, Bellvitge University Hospital, Research Group of Hepato-biliary and Pancreatic Diseases, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, University of Barcelona L'Hospitalet de Llobregat, Barcelona, Spain
| | - N Peláez
- Department of Hepatobiliary and Pancreatic Surgery, Bellvitge University Hospital, Research Group of Hepato-biliary and Pancreatic Diseases, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, University of Barcelona L'Hospitalet de Llobregat, Barcelona, Spain
| | - S Salord
- Departament de Ciències Clíniques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain; Department of Digestive Diseases Unit. Bellvitge University Hospital, Research Group of Hepato-biliary and Pancreatic Diseases, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, University of Barcelona L'Hospitalet de Llobregat, Barcelona, Spain
| | - R Lopez-Urdiales
- Department of Endocrinology and Nutrition, Bellvitge University Hospital, Barcelona, Spain
| | - J Fabregat
- Department of Hepatobiliary and Pancreatic Surgery, Bellvitge University Hospital, Research Group of Hepato-biliary and Pancreatic Diseases, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, University of Barcelona L'Hospitalet de Llobregat, Barcelona, Spain; Departament de Ciències Clíniques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - J Busquets
- Department of Hepatobiliary and Pancreatic Surgery, Bellvitge University Hospital, Research Group of Hepato-biliary and Pancreatic Diseases, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, University of Barcelona L'Hospitalet de Llobregat, Barcelona, Spain; Departament de Ciències Clíniques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain.
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Adler DG. G-POEM for refractory gastroparesis after gastric pacer placement: moving things forward. Gastrointest Endosc 2023; 98:567-568. [PMID: 37734814 DOI: 10.1016/j.gie.2023.05.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/12/2023] [Accepted: 05/14/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Douglas G Adler
- Center for Advanced Therapeutic Endoscopy, Centura Health, Porter Adventist Hospital, Denver, Colorado, USA
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Ichkhanian Y, Al-Haddad MA, Jacobs CC, Schlachterman A, Yang J, Canakis A, Kim R, Guerson-Gil A, D'Souza LS, Alsheik E, Ginnebaugh BD, Khashab MA, Zuchelli T, McFarlin K, Piraka C. Gastric peroral endoscopic myotomy for management of refractory gastroparesis in patients with gastric neurostimulator devices: a multicenter retrospective case control study. Gastrointest Endosc 2023; 98:559-566.e1. [PMID: 37121364 DOI: 10.1016/j.gie.2023.04.2079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/28/2023] [Accepted: 04/19/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND AND AIMS Gastric neurostimulation (GNS) and gastric peroral myotomy (G-POEM), therapies for refractory gastroparesis, are associated with suboptimal outcomes. We studied the role of G-POEM as a salvage therapy in patients with refractory symptoms after GNS implantation. METHODS This was a multicenter, retrospective, matched case-control study. Consecutive patients with a GNS device and who underwent G-POEM as a salvage therapy for clinical failure (cases) and patients without GNS implantation and who underwent G-POEM for refractory gastroparesis (control) between October 2018 and August 2021 were included. The primary outcome was clinical success after G-POEM. RESULTS A total of 123 patients (mean age 45.7 ± 14.7 years; 88 female subjects [72%]) underwent G-POEM therapy during the study: 41 cases and 82 controls. Clinical success was achieved in 66% in the case group and 65% in the control group (P = .311), during a median total clinical follow-up time of 11.8 (interquartile range, 2.4-6.3) months. In the case group, the mean Gastroparesis Cardinal Symptom Index score decreased from 2.8 ± 1.8 to 1.5 ± 1.9 (P = .024), and gastric retention at 4 hours improved from 45% ± 25.8% to 16.6% ± 13.1% (P = .06). The mean delta improvement in the subscales of nausea/vomiting (1.3 ± .6 vs .9 ± 1.1, P = .044) and bloating (1.6 ± 1.3 vs 1.2 ± 1.4, P = .041) were significantly higher in cases than in controls. CONCLUSIONS Among patients with refractory symptoms after GNS, G-POEM can be a reasonable salvage therapy to provide further symptomatic relief with evidence of a potential additive effect of both G-POEM and GNS.
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Affiliation(s)
| | - Mohammad A Al-Haddad
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana, USA
| | - Chelsea C Jacobs
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana, USA
| | - Alexander Schlachterman
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Juliana Yang
- Division of Gastroenterology and Hepatology, Vanderbilt University, Nashville, Tennessee, USA
| | - Andrew Canakis
- Division of Gastroenterology and Hepatology, University of Maryland, Baltimore, Maryland, USA
| | - Raymond Kim
- Division of Gastroenterology and Hepatology, University of Maryland, Baltimore, Maryland, USA
| | - Arcelia Guerson-Gil
- Division of Gastroenterology and Hepatology, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Lionel S D'Souza
- Division of Gastroenterology and Hepatology, Stony Brook University Hospital, Stony Brook, New York, USA
| | | | | | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, Maryland, USA (10)Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | | | - Kellie McFarlin
- Department of Surgery, Henry Ford Hospital, Detroit, Michigan, USA
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Peppas S, Ahmad AI, Altork N, Cho WK. Efficacy and safety of gastric per-oral endoscopic myotomy (GPOEM) in lung transplant patients with refractory gastroparesis: a systematic review and meta-analysis. Surg Endosc 2023; 37:6695-6703. [PMID: 37479838 DOI: 10.1007/s00464-023-10287-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 07/05/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Post-lung transplant gastroparesis is a frequent debilitating complication of lung transplant recipients, as it can increase the risk for gastro-esophageal reflux disease and subsequent graft dysfunction. We performed a systematic review and meta-analysis to evaluate the efficacy and safety of GPOEM in lung transplant patients with refractory gastroparesis. METHODS The present systematic review and meta-analysis wer performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. We selected studies that analyzed the gastroparesis cardinal symptom index (GCSI) before and after the procedure to verify the efficacy of GPOEM. Random-effects model was used and the analysis was performed with STATA 17. RESULTS Four observational studies (one conference abstract) with 104 patients were included in the meta-analysis. Prior treatments for gastroparesis included prokinetic agents and botulinum toxin in 78% (78/104) and 66.7% (66/99), respectively. Pooled estimate for clinical efficacy of GPOEM was 83% (95% CI 76%-90%). The pooled mean reduction in GCSI following the procedure was - 2.01 (- 2.35, - 1.65, p = 0.014). Three studies reported statistically significant improvement of gastro-esophageal retention or emptying in the post-GPOEM period. 30-day post-operative complications included minor or major bleeding (11.6%), severe reflux (1.2%), and pyloric stenosis (1.2%) requiring re-intervention. 90-day all-cause mortality was 2.6% with one patient dying from severe allograft rejection. CONCLUSION Our study showed that GPOEM is an effective and safe strategy for lung transplant patients with refractory gastroparesis and should be considered as a therapeutic strategy in this population. Larger multicenter trials are needed in the future to further evaluate the effect of GPOEM on allograft function and rates of rejection.
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Affiliation(s)
- Spyros Peppas
- Department of Medicine, MedStar Washington Hospital Center, Washington, DC, USA.
| | - Akram I Ahmad
- Department of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Nadera Altork
- Department of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Won Kyoo Cho
- Georgetown University School of Medicine, Washington, DC, USA
- Division of Gastroenterology/Hepatology, INOVA Health System Leesburg, Leesburg, VA, USA
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Tran D, Leeds SG, Fair L, Fang J, Rubarth C, McGowan T, Ramakrishnan S, Ogola G, Aladegbami B, Ward MA. Gastric per-oral endoscopic myotomy versus pyloric injection of botulinum toxin for the treatment of gastroparesis: our institutional experience and a systematic review of the literature. Surg Endosc 2023; 37:7280-7287. [PMID: 37430121 DOI: 10.1007/s00464-023-10262-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/27/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION Gastric Per-Oral Endoscopic Myotomy (GPOEM) has been developed as an effective treatment option for patients with medically refractory gastroparesis. Other endoscopic options, such as pyloric injection of botulinum toxin (Botox), is often performed with limited efficacy. The purpose of this study was to evaluate GPOEM for the treatment of gastroparesis and compare its efficacy to Botox injection results reported in the literature. METHODS A retrospective review was conducted to identify all patients who underwent a GPOEM for the treatment of gastroparesis between September 2018 and June 2022. Changes in Gastric Emptying Scintigraphy (GES) studies and Gastroparesis Cardinal Symptom (GCSI) scores from the preoperative to postoperative period were analyzed. In addition, a systematic review was conducted to identify all publications reporting the outcomes of Botox injections for the treatment of gastroparesis. RESULTS A total of 65 patients (51 female, 14 male) underwent a GPOEM during the study period. Twenty-eight patients (22 female, 6 male) had both preoperative and postoperative GES studies in addition to GCSI scores. The etiologies of gastroparesis were diabetic (n = 4), idiopathic (n = 18), and postsurgical (n = 6). Fifty percent of these patients had undergone previous failed interventions including Botox injections (n = 6), gastric stimulator placement (n = 2), and endoscopic pyloric dilation (n = 6). Outcomes showed a significant decrease in GES percentages (mean difference = - 23.5%, p < 0.001) and GCSI scores (mean difference = - 9.6, p = 0.02) postoperatively. In the systematic review for Botox, transient mean improvements in postoperative GES percentages and GCSI scores were reported at 10.1% and 4.0, respectively. CONCLUSION GPOEM leads to significant improvement in GES percentages and GCSI scores postoperatively and is superior to Botox injection results reported in the literature.
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Affiliation(s)
- Daniel Tran
- Texas A&M College of Medicine, Bryan, TX, USA
| | - Steven G Leeds
- Department of Minimally Invasive Surgery, Baylor University Medical Center, 3417 Gaston Avenue, Suite 965, Dallas, TX, 75246, USA
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA
- Texas A&M College of Medicine, Bryan, TX, USA
| | - Lucas Fair
- Department of Minimally Invasive Surgery, Baylor University Medical Center, 3417 Gaston Avenue, Suite 965, Dallas, TX, 75246, USA
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA
- Research Institute, Baylor Scott and White Health, Dallas, TX, USA
| | - Jenifer Fang
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA
| | - Charles Rubarth
- Research Institute, Baylor Scott and White Health, Dallas, TX, USA
| | - Titus McGowan
- Research Institute, Baylor Scott and White Health, Dallas, TX, USA
| | - Sudha Ramakrishnan
- Baylor Health Sciences Library, Baylor Scott and White Health, Dallas, TX, USA
| | - Gerald Ogola
- Research Institute, Baylor Scott and White Health, Dallas, TX, USA
| | - Bola Aladegbami
- Department of Minimally Invasive Surgery, Baylor University Medical Center, 3417 Gaston Avenue, Suite 965, Dallas, TX, 75246, USA
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA
- Texas A&M College of Medicine, Bryan, TX, USA
| | - Marc A Ward
- Department of Minimally Invasive Surgery, Baylor University Medical Center, 3417 Gaston Avenue, Suite 965, Dallas, TX, 75246, USA.
- Center for Advanced Surgery, Baylor Scott and White Health, Dallas, TX, USA.
- Texas A&M College of Medicine, Bryan, TX, USA.
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Wang Y, Zhang C, Zhao D. Achalasia Combined with Idiopathic Gastroparesis Treated with Peroral Endoscopic Myotomy and Gastric Peroral Endoscopic Myotomy in a Single Procedure. Turk J Gastroenterol 2023; 34:982-983. [PMID: 37674441 PMCID: PMC10544314 DOI: 10.5152/tjg.2023.23276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/19/2023] [Indexed: 09/08/2023]
Affiliation(s)
- Yating Wang
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Chunxi Zhang
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Dongqiang Zhao
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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15
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Eriksson SE, Zheng P, Sarici IS, Shen X, Jobe BA, Ayazi S. The impact of delayed gastric emptying as measured by gastric emptying scintigraphy on the outcome of magnetic sphincter augmentation. Surg Endosc 2023; 37:7144-7152. [PMID: 37328595 PMCID: PMC10462528 DOI: 10.1007/s00464-023-10190-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 05/30/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION The impact of delayed gastric emptying (DGE) on the outcome of anti-reflux surgery (ARS) is controversial. There is concern that poor gastric emptying diminishes outcomes. Magnetic sphincter augmentation (MSA) may have a comparatively mild impact on gastric physiology, but the relationship between DGE and MSA outcomes is unknown. This study aims to evaluate the relationship between objective DGE and MSA outcomes over time. METHODS Patients who completed gastric emptying scintigraphy (GES) prior to MSA between 2013 and 2021 were included. DGE was defined as a 4 h retention > 10% or half emptying time > 90 min on GES. Outcomes were compared between DGE and normal gastric emptying (NGE) groups at 6 months, 1 and 2 years. Sub-analysis of patients with severe (> 35%) DGE and correlation analysis between 4-h retention and symptom and acid-normalization were performed. RESULTS The study population consisted of 26 (19.8%) patients with DGE and 105 with NGE. DGE was associated with more 90-days readmissions (18.5 vs 2.9%, p = 0.009). At 6 months patients with DGE had higher median (IQR) GERD-HRQL total [17.0(10-29) vs 5.5(3-16), p = 0.0013], heartburn [1(1-3) vs 0(0-1), p = 0.0010) and gas-bloat [4(2-5) vs 2(1-3), p = 0.033] scores. Outcomes at 1 and 2 years follow-up were comparable (p > 0.05). From 6 months to 1-year the gas-bloat score decreased from 4(2-5) to 3(1-3), p = 0.041. Total and heartburn scores decreased, but not significantly. Severe DGE (n = 4) patients had lower antiacid medication freedom at 6 months (75 vs 87%, p = 0.014) and 1-year (50 vs 92%, p = 0.046). There were non-significant trends for higher GERD-HRQL scores, dissatisfaction, and removal rates in severe DGE at 6 months and 1-year. There was a weak correlation between 4-h retention and 6-month GERD-HRQL total score [R = 0.253, 95%CI (0.09-0.41), p = 0.039], but not acid-normalization (p > 0.05). CONCLUSION Outcomes after MSA are diminished early on in patients with mild-to-moderate DGE, but comparable by 1 year and durable at 2 years. Severe DGE outcomes may be suboptimal.
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Affiliation(s)
- Sven E Eriksson
- Esophageal Institute, Allegheny Health Network, 4815 Liberty Avenue, Suite 439, Pittsburgh, PA, 15224, USA
| | - Ping Zheng
- Esophageal Institute, Allegheny Health Network, 4815 Liberty Avenue, Suite 439, Pittsburgh, PA, 15224, USA
| | - Inanc S Sarici
- Esophageal Institute, Allegheny Health Network, 4815 Liberty Avenue, Suite 439, Pittsburgh, PA, 15224, USA
| | - Xinxin Shen
- Esophageal Institute, Allegheny Health Network, 4815 Liberty Avenue, Suite 439, Pittsburgh, PA, 15224, USA
| | - Blair A Jobe
- Esophageal Institute, Allegheny Health Network, 4815 Liberty Avenue, Suite 439, Pittsburgh, PA, 15224, USA
- Department of Surgery, Drexel University, Philadelphia, PA, USA
| | - Shahin Ayazi
- Esophageal Institute, Allegheny Health Network, 4815 Liberty Avenue, Suite 439, Pittsburgh, PA, 15224, USA.
- Department of Surgery, Drexel University, Philadelphia, PA, USA.
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16
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Serradilla Martín M, Villodre Tudela C, Rotellar F, Blanco Fernández G, Ramia JM. Delayed gastric emptying after distal pancreatectomy. Cir Esp 2023; 101:574-576. [PMID: 36933890 DOI: 10.1016/j.cireng.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 10/20/2022] [Accepted: 12/10/2022] [Indexed: 03/18/2023]
Affiliation(s)
- Mario Serradilla Martín
- Instituto de Investigación Sanitaria Aragón, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | - Celia Villodre Tudela
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Dr. Balmis, Alicante, Spain; Instituto de Investigación ISABIAL, Alicante, Spain
| | - Fernando Rotellar
- Clínica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNa), Pamplona, Spain
| | | | - José Manuel Ramia
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Dr. Balmis, Alicante, Spain; Instituto de Investigación ISABIAL, Alicante, Spain; Universidad Miguel Hernández, Elche, Spain
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17
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Yu Z, Zhao X, Qiu S, Liu N, Li P, Zhou S. Risk Factor Analysis of Gastroparesis Syndrome in 2652 Patients with Radical Distal Gastrectomy. J Gastrointest Surg 2023; 27:1568-1577. [PMID: 37127770 DOI: 10.1007/s11605-022-05538-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/13/2022] [Indexed: 05/03/2023]
Abstract
OBJECTIVE The aim of this study is to investigate the risk factors of postoperative gastroparesis syndrome (PGS) in patients with gastric cancer who underwent radical distal gastrectomy. METHODS The clinical data of 2652 patients with gastric cancer who underwent radical distal gastrectomy in the past 10 years were retrospectively analyzed. Furthermore, the incidence of PGS was set as the dependent variable, and the risk factors for PGS were screened using univariate and multivariate logistic regression analyses. Risk factor analysis for the different digestive tract reconstruction methods was also performed. RESULTS Univariate analysis revealed that preoperative pyloric obstruction (p = 0.001), digestive tract reconstruction (p = 0.001), jejunum nutrition tube application (p = 0.001), intraperitoneal chemotherapy drug application (p = 0.002), age (≥ 66 years or < 66 years) (p = 0.042), operative time (≥ 184.5 min or < 184.5 min) (p = 0.049), and postoperative indwelling catheter time (≥ 4.5 days or < 4.5 days) (p = 0.045) were related to PGS. Multivariate logistic regression analysis showed that preoperative pyloric obstruction (odds ratio (OR) = 2.830, p = 0.004), application of a jejunum nutrition tube (OR = 3.309, p = 0.011), intraperitoneal chemotherapy (OR = 0.482, p = 0.010), and digestive tract reconstruction were independent risk factors for PGS. CONCLUSION This study identified risk factors associated with PGS, which could be further applied in clinical practice.
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Affiliation(s)
- Zhiyuan Yu
- School of Medicine, Nankai University, Weijin Road 94, Nankai District, Tianjin, 300071, China
- Medical School of Chinese PLA, Fuxing Road 28, Haidian District, Beijing, 100039, China
- Senior Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100039, China
| | - Xudong Zhao
- Senior Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100039, China
| | - Shuzhong Qiu
- Medical School of Chinese PLA, Fuxing Road 28, Haidian District, Beijing, 100039, China
| | - Na Liu
- Medical School of Chinese PLA, Fuxing Road 28, Haidian District, Beijing, 100039, China
- Senior Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100039, China
| | - Peiyu Li
- School of Medicine, Nankai University, Weijin Road 94, Nankai District, Tianjin, 300071, China
- Medical School of Chinese PLA, Fuxing Road 28, Haidian District, Beijing, 100039, China
- Senior Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100039, China
| | - Sixin Zhou
- Senior Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100039, China.
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18
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Hustak R, Vackova Z, Krajciova J, Spicak J, Kieslichova E, Mares J, Martinek J. Endoscopic clips versus overstitch suturing system device for mucosotomy closure after peroral endoscopic pyloromyotomy (G-POEM): a prospective single-center study. Surg Endosc 2022; 36:9254-9261. [PMID: 35851820 DOI: 10.1007/s00464-022-09417-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 06/24/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIMS G-POEM is an emerging method for treatment of severe gastroparesis. Safe mucosal closure is necessary to avoid adverse events. The aim of this study was to compare the efficacy of two closure methods: clips and endoscopic suturing (ES) after G-POEM. METHODS We performed a single center, prospective study. The closure method was assigned at the discretion of an endoscopist prior to the procedure. The main outcome was the proportion of subjects with successful closure. Unsuccessful closure was defined as a need for a rescue method, or a need for an additional intervention or incomplete closure-related adverse events. Secondary outcomes were the easiness of closure (VAS score 1 = very difficult, 10 = easy), closure time, and cost. RESULTS A total of 40 patients [21 female; mean age, range 47.5; (20-74)] were included; 20 received ES and 20 clips [mean number of clips 6; range (4-19)]. All 20 patients with ES (100%, 95% CI 84-100%) and 18 patients with clips (89%, 95% CI 70-97%) had successful closure (p = 0.49). One patient needed a rescue method (KING closure) and the other patient an additional clipping on POD1. Closure with clips was quicker [mean time 9.8 (range 4-20) min vs. 14.1 (5-21) min; p = 0.007] and cheaper [mean cost 807 USD (± 402) vs. 2353 USD (± 145); p < 0.001]. Endoscopist assessed the easiness of ES and clips as comparable [mean VAS, range 7.5 (3-10) (ES) vs. 6.9 (3-10) (clips); p = 0.3]. CONCLUSIONS Both ES and clips are effective methods for mucosal closure in patients undergoing G-POEM. However, centres using clips should have a rescue closure method available as clips may fail in some patients. Closure with ES is more costly than with clips.
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Affiliation(s)
- R Hustak
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
- Institute of Physiology, Charles University in Prague, Prague, Czech Republic
- Department of Internal Medicine, University Hospital Trnava, Trnava, Slovakia
| | - Z Vackova
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
- Institute of Physiology, Charles University in Prague, Prague, Czech Republic
| | - J Krajciova
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
- Institute of Physiology, Charles University in Prague, Prague, Czech Republic
| | - J Spicak
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - E Kieslichova
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - J Mares
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jan Martinek
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
- Institute of Physiology, Charles University in Prague, Prague, Czech Republic.
- Faculty of Medicine, Ostrava University, Ostrava, Czech Republic.
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Videnska 1921, 140 21, Prague 4, Czech Republic.
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Soliman H, Oiknine E, Cohen-Sors B, Moszkowicz D, Gorbatchef C, Dior M, Nebunu N, Le Gall M, Coffin B, Duboc H. Efficacy and safety of endoscopic pyloric balloon dilation in patients with refractory gastroparesis. Surg Endosc 2022; 36:8012-8020. [PMID: 35437639 DOI: 10.1007/s00464-022-09230-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/29/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIMS There has been interest in the use of pyloric therapies for the treatment of refractory gastroparesis. However, data on endoscopic pyloric dilation are scarce. We aimed to assess the efficacy and safety of this procedure in refractory gastroparesis. METHODS We performed a retrospective analysis of 47 patients referred for refractory gastroparesis, confirmed by gastric emptying scintigraphy, and treated with endoscopic pyloric through-the-scope balloon dilation. The primary endpoint was the effectiveness of the procedure, evaluated with the Gastric Cardinal Symptom Index (GCSI) at 2 and 6 months. RESULTS A clinical response, defined by a 1.0 point decrease in the GCSI score, was observed in 25 patients at 2 months (53%) and in 19 patients at 6 months (40%). The mean GCSI score decreased significantly at 2 and 6 months compared to the preoperative score (3.9 ± 0.87 vs 2.3 ± 1.37 and 3.9 ± 0.87 vs 2.9 ± 1.27, respectively; p < 0.0001). No complication was observed. Nine patients had a delayed relapse at 1 year. A second dilation was performed for eight patients and it was effective in five of them (63%). The mean follow-up time of the patients was 27.0 ± 10.4 months. At 2 years, 15 patients still experienced improvement following this treatment (32%). No predictive factor of clinical response was identified. CONCLUSION The efficacy of pyloric dilation is 53% at 2 months, with sustained improvement in one third of patients at 2 years. This treatment should be considered as an alternative option to pyloromyotomy.
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Affiliation(s)
- Heithem Soliman
- Centre de Recherche Sur L'Inflammation, Université de Paris Cité, Inserm UMRS 1149, 75018, Paris, France.
- Hépato Gastro Entérologie, Hôpital Louis Mourier, DMU ESPRIT - GHU (AP-HP), 178 rue des Renouillers, 92700, Colombes, France.
| | - Elsa Oiknine
- Hépato Gastro Entérologie, Hôpital Louis Mourier, DMU ESPRIT - GHU (AP-HP), 178 rue des Renouillers, 92700, Colombes, France
| | - Boris Cohen-Sors
- Hépato Gastro Entérologie, Hôpital Louis Mourier, DMU ESPRIT - GHU (AP-HP), 178 rue des Renouillers, 92700, Colombes, France
| | - David Moszkowicz
- Service de Chirurgie Générale Et Digestive, AP-HP, Hôpital Louis Mourier, DMU ESPRIT-GHU AP-HP, Nord-Université de Paris, 92700, Colombes, France
| | - Caroline Gorbatchef
- Hépato Gastro Entérologie, Hôpital Louis Mourier, DMU ESPRIT - GHU (AP-HP), 178 rue des Renouillers, 92700, Colombes, France
| | - Marie Dior
- Hépato Gastro Entérologie, Hôpital Louis Mourier, DMU ESPRIT - GHU (AP-HP), 178 rue des Renouillers, 92700, Colombes, France
| | - Nicoleta Nebunu
- Hépato Gastro Entérologie, Hôpital Louis Mourier, DMU ESPRIT - GHU (AP-HP), 178 rue des Renouillers, 92700, Colombes, France
| | - Maude Le Gall
- Centre de Recherche Sur L'Inflammation, Université de Paris Cité, Inserm UMRS 1149, 75018, Paris, France
| | - Benoit Coffin
- Centre de Recherche Sur L'Inflammation, Université de Paris Cité, Inserm UMRS 1149, 75018, Paris, France
- Hépato Gastro Entérologie, Hôpital Louis Mourier, DMU ESPRIT - GHU (AP-HP), 178 rue des Renouillers, 92700, Colombes, France
| | - Henri Duboc
- Centre de Recherche Sur L'Inflammation, Université de Paris Cité, Inserm UMRS 1149, 75018, Paris, France
- Hépato Gastro Entérologie, Hôpital Louis Mourier, DMU ESPRIT - GHU (AP-HP), 178 rue des Renouillers, 92700, Colombes, France
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Martinek J, Hustak R, Mares J, Vackova Z, Spicak J, Kieslichova E, Buncova M, Pohl D, Amin S, Tack J. Endoscopic pyloromyotomy for the treatment of severe and refractory gastroparesis: a pilot, randomised, sham-controlled trial. Gut 2022; 71:2170-2178. [PMID: 35470243 PMCID: PMC9554080 DOI: 10.1136/gutjnl-2022-326904] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/05/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Endoscopic pyloromyotomy (G-POEM) is a minimally invasive treatment option with promising uncontrolled outcome results in patients with gastroparesis. DESIGN In this prospective randomised trial, we compared G-POEM with a sham procedure in patients with severe gastroparesis. The primary outcome was the proportion of patients with treatment success (defined as a decrease in the Gastroparesis Cardinal Symptom Index (GCSI) by at least 50%) at 6 months. Patients randomised to the sham group with persistent symptoms were offered cross-over G-POEM. RESULTS The enrolment was stopped after the interim analysis by the Data and Safety Monitoring Board prior to reaching the planned sample of 86 patients. A total of 41 patients (17 diabetic, 13 postsurgical, 11 idiopathic; 46% male) were randomised (21 G-POEM, 20-sham). Treatment success rate was 71% (95% CI 50 to 86) after G-POEM versus 22% (8-47) after sham (p=0.005). Treatment success in patients with diabetic, postsurgical and idiopathic gastroparesis was 89% (95% CI 56 to 98), 50% (18-82) and 67% (30-90) after G-POEM; the corresponding rates in the sham group were 17% (3-57), 29% (7-67) and 20% (3-67).Median gastric retention at 4 hours decreased from 22% (95% CI 17 to 31) to 12% (5-22) after G-POEM and did not change after sham: 26% (18-39) versus 24% (11-35). Twelve patients crossed over to G-POEM with 9 of them (75%) achieving treatment success. CONCLUSION In severe gastroparesis, G-POEM is superior to a sham procedure for improving both symptoms and gastric emptying 6 months after the procedure. These results are not entirely conclusive in patients with idiopathic and postsurgical aetiologies. TRIAL REGISTRATION NUMBER NCT03356067; ClinicalTrials.gov.
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Affiliation(s)
- Jan Martinek
- Department of Hepatogastroenterology, Institute of Clinical and Experimental Medicine, Praha, Czech Republic
| | - Rastislav Hustak
- Department of Internal Medicine, University Hospital Trnava, Trnava, Slovakia
- Institute of Physiology, Charles University in Prague, Prague, Czech Republic
| | - Jan Mares
- Department of IT and Biostatistics, Institute of Clinical and Experimental Medicine, Praha, Czech Republic
| | - Zuzana Vackova
- Department of Hepatogastroenterology, Institute of Clinical and Experimental Medicine, Praha, Czech Republic
| | - Julius Spicak
- Department of Hepatogastroenterology, Institute of Clinical and Experimental Medicine, Praha, Czech Republic
| | - Eva Kieslichova
- Department of Anesthesiology and Intensive Care, Institute of Clinical and Experimental Medicine, Praha, Czech Republic
| | - Marie Buncova
- Department of Nuclear Medicine, Institute of Clinical and Experimental Medicine, Praha, Czech Republic
| | - Daniel Pohl
- Division of Gastroenterology & Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Sunil Amin
- Division of Gastroenterology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jan Tack
- Clinical and Experimental Medicine, University of Leuven, Leuven, Belgium
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Gapp J, Crigler C, Ansari Z, Mittal S, Reddymasu S, Chandra S, Nandipati K. Transpyloric Lumen-Apposing Metal Stent for Gastroparesis Is Associated with Significant Complications. J Gastrointest Surg 2022; 26:2212-2214. [PMID: 35614285 DOI: 10.1007/s11605-022-05357-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 04/30/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Jonathan Gapp
- Department of Medicine, Division of Gastroenterology, CHI-Creighton University School of Medicine, Omaha, NE, USA
| | | | - Zaid Ansari
- Department of Medicine, Division of Gastroenterology, Saint Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Sumeet Mittal
- Department of Surgery, Saint Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Savio Reddymasu
- Department of Medicine, Division of Gastroenterology, Saint Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Subhash Chandra
- Department of Medicine, Division of Gastroenterology, Saint Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Kalyana Nandipati
- Department of Surgery, CHI-Creighton University School of Medicine, 7710 Mercy Road, Suite 501, Omaha, NE, 68124, USA.
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22
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Chi P, Huang SH. [Delayed gastric emptying after surgery for transverse colon cancer: diagnosis, management and prevention]. Zhonghua Wei Chang Wai Ke Za Zhi 2022; 25:493-499. [PMID: 35754213 DOI: 10.3760/cma.j.cn441530-20220304-00082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Delayed gastric emptying is a syndrome of gastric motility disorder with slow gastric emptying as the main sign, provided that mechanical factors such as intestinal obstruction and anastomotic stricture are excluded. The incidence of delayed gastric emptying after colon cancer surgery is 1.4%, mainly after transverse colon cancer surgery. Most of the studies on delayed gastric emptying are case reports, lacking systematic studies. The diagnoses and treatments can be draw on the experience of delayed gastric emptying after pancreatic surgery. Our retrospective study indicated that the incidence of delayed gastric emptying after surgery for transverse colon cancer was 4.0%, higher than that for other colon cancer. Patients who underwent gastrocolic ligament lymph node dissection were at higher risk than those who did not (3.6% vs. 0.8%). Gastrocolic ligament lymph node dissection and stress are causative factors for delayed gastric emptying after surgery for transverse colon cancer. We add the gastrografin test upon the diagnostic criteria of the International Study Group for Pancreatic Surgery, which is simple and practical. Nasogastric tube decompression, enteral nutrition combined with parenteral nutrition, glucocorticoids, and prokinetic agents can cure most patients with postoperative delayed gastric emptying. All the patients with postoperative delayed gastric emptying were cured in our studies. Strict indications for gastrocolic ligament lymph node dissection (patients with cT3-4 and cN+) may decrease the occurrence of delayed gastric emptying after surgery for transverse colon cancer.
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Affiliation(s)
- P Chi
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou 350001, China
| | - S H Huang
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou 350001, China
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Kondajji A, Klingler M, Tu C, Kelley R, El-Hayek K, Rodriquez J, Cline M, Fathalizadeh A, Allemang M. Gastroparesis with concomitant gastrointestinal dysmotility is not a contraindication for per-oral pyloromyotomy (POP). Surg Endosc 2022; 36:4226-4232. [PMID: 34642799 DOI: 10.1007/s00464-021-08756-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 09/27/2021] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Per-oral pyloromyotomy (POP or G-POEM) provides significant short-term improvements in symptoms and objective emptying for patients with medically refractory gastroparesis, but it is unclear if patients with gastroparesis and co-existing dysmotility (small bowel or colonic delay) also benefit. In this study, we used wireless motility capsule (WMC) data to measure outcomes in patients with isolated gastroparesis (GP) and gastroparesis with co-existing dysmotility (GP + Dys) who underwent POP. METHODS We retrospectively analyzed patients who had POP and completed WMC data during their evaluation of intestinal dysmotility. WMC data were reviewed to identify patients who demonstrated isolated GP or GP + Dys. Each patient's pre-op and post-op Gastroparesis Cardinal Symptom Index (GCSI) and 4-h solid-phase scintigraphy gastric emptying studies (GES) scores were compared to evaluate improvement. RESULTS Of the entire cohort (n = 73), 89% were female with a mean age of 47.0 ± 15.0 years old. Gastroparesis etiologies were divided among idiopathic (54.8%), diabetic (26%), postsurgical (8.2%), autoimmune (5.5%), and multifactorial (5.5%). Forty-one patients (56%) had GP and 32 patients (44%) had GP + Dys. GCSI improved after POP whether the patient had isolated GP (- 12.31, p < 0.001) or GP + Dys (- 9.58, p < 0.001); however, there was no significant difference in total GCSI improvement between the two groups. A subset of patients had postoperative GES available (n = 47). In the isolated GP and GP + Dys cohorts, 15/28 (54%) and 12/19 (63%) patients had normal post-op 4-h GES, respectively, but no statistical difference between the two groups. CONCLUSION Patients with medically refractory gastroparesis with and without concomitant gastrointestinal dysmotility show short-term subjective and objective improvement after POP. Concomitant small bowel or colonic dysmotility should not deter physicians from offering POP in carefully selected patients with gastroparesis.
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Affiliation(s)
- Abhiram Kondajji
- Digestive Disease and Surgical Institute, Cleveland Clinic, Cleveland, OH, USA.
- General Surgery Resident, Cleveland Clinic-South Pointe Hospital, 20000 Harvard Road, Warrensville Height, OH, 44122, USA.
| | - Michael Klingler
- Digestive Disease and Surgical Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Chao Tu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Rebecca Kelley
- Dermatology and Plastic Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - John Rodriquez
- Digestive Disease and Surgical Institute, Cleveland Clinic, Abu Dhabi, UAE
| | - Michael Cline
- Digestive Disease and Surgical Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alisan Fathalizadeh
- Digestive Disease and Surgical Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Matthew Allemang
- Digestive Disease and Surgical Institute, Cleveland Clinic, Cleveland, OH, USA
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24
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Reja M, Mishra A, Tyberg A, Andalib I, Martínez GM, Zamarripa F, Gaidhane M, Nieto J, Kahaleh M. Gastric Peroral Endoscopic Myotomy: A Specific Learning Curve. J Clin Gastroenterol 2022; 56:339-342. [PMID: 34009842 DOI: 10.1097/mcg.0000000000001537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 02/18/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Gastric peroral endoscopic pyloromyotomy (G-POEM) is a novel option for patients with gastroparesis. It involves submucosal tunneling across the pylorus, followed by pyloromyotomy, and subsequent closure of the endoscopic tunnel. The aim of this study was to determine the learning curve for G-POEM. METHODS Consecutive patients undergoing G-POEM by a single operator were included from a prospective registry over 2 years. Demographics, procedure info, postprocedure follow-up data, and adverse events were collected. Nonlinear regression and cumulative sum control chart analyses were conducted for the learning curve. Clinical outcomes were improvement in Gastroparesis Cardinal Symptom Index score and gastric emptying scintigraphy. RESULTS Thirty-six patients were included (16.7% M, mean age 46 y). The majority had idiopathic gastroparesis (n=16, 44%), with the remaining having diabetes (n=5, 17%), postsurgical (n=10, 28%), or other (n=4, 11%). Technical success was achieved in 35 of 36 (97%). There was a significant reduction in the total Gastroparesis Cardinal Symptom Index score (2.09 units, P<0.00001) and a significant reduction in postoperative gastric emptying scintigraphy (82.44 mins, P<0.00001). Mean follow-up was 15 months (SD, 1.05). Median procedure time was 60.5 minutes (range, 35 to 136). Cumulative sum control chart shows 60-minute procedure was achieved at the 18th procedure. Procedure durations further reduced with consequent procedures with the last 3 being 45 minutes, thus demonstrating continued improvement with ongoing experience (nonlinear regression P<0.0001). CONCLUSION Endoscopists experienced in G-POEM are expected to achieve a reduction in procedure time over successive cases, with efficiency reached at 60.5 minutes and a learning rate of 18 cases with continuing improvement.
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Affiliation(s)
- Mishal Reja
- Rutgers Robert Wood Johnson Medical School, New Brunswick
| | | | - Amy Tyberg
- Rutgers Robert Wood Johnson Medical School, New Brunswick
| | - Iman Andalib
- Ichan School of Medicine, Mount Sinai, New York, NY
| | | | | | | | | | - Michel Kahaleh
- Rutgers Robert Wood Johnson Medical School, New Brunswick
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Dražilová D, Vacková Z, Husťak R, Buncová M, Martínek J. Successful repeated gastric peroral endoscopic myotomy (re-G-POEM) in the treatment of postsurgical gastroparesis. Rozhl Chir 2022; 101:37-41. [PMID: 35148615 DOI: 10.33699/pis.2022.101.1.37-41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Gastric peroral endoscopic myotomy (G-POEM) is a promising but still experimental endoscopic method for the treatment of gastroparesis. CASE REPORT We describe the case of a 31 years old female patient with severe refractory postsurgical gastroparesis preceded by fundoplication done for reflux disease. She has had digestive problems since childhood. In 2018, the first G-POEM was performed but did not lead to any clinical improvement. We proposed to perform a repeated G-POEM given that impedance planimetry measurement showed persistent pylorospasm. The patient agreed and the second G-POEM was performed in February 2021 (the first re-G-POEM in the Czech Republic) with a satisfactory clinical result; a subsequent gastric emptying study also showed a significant improvement. CONCLUSION This case report shows the feasibility of performing a repeated endoscopic pyloromyotomy in patients with gastroparesis and proven pylorospasm. One can only hypothesize whether the lack of effect of the first procedure was caused by an incomplete myotomy (failure of the procedure) or the need for a double myotomy, which is considered a standard in some centers.
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26
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Kamal F, Khan MA, Lee-Smith W, Sharma S, Acharya A, Jowhar D, Farooq U, Aziz M, Kouanda A, Dai SC, Howden CW, Munroe CA. Systematic review with meta-analysis: one-year outcomes of gastric peroral endoscopic myotomy for refractory gastroparesis. Aliment Pharmacol Ther 2022; 55:168-177. [PMID: 34854102 DOI: 10.1111/apt.16725] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/05/2021] [Accepted: 11/22/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Several studies have examined the efficacy of gastric peroral endoscopic myotomy (G-POEM) for gastroparesis. AIM To evaluate the mid-term efficacy of G-POEM by meta-analysis of studies with a minimum 1 year of follow-up. METHODS We reviewed several databases from inception to 10 June 2021 to identify studies that evaluated the efficacy of G-POEM in refractory gastroparesis, and had at least 1 year of follow-up. Our outcomes of interest were clinical success at 1 year, adverse events, difference in mean pre- and 1 year post-procedure Gastroparesis Cardinal Symptom Index (GCSI) score, and difference in mean pre- and post-procedure EndoFLIP measurements. We analysed data using a random-effects model and assessed heterogeneity by I2 statistic. RESULTS We included 10 studies comprising 482 patients. Pooled rates (95% CI) of clinical success at 1 year and adverse events were 61% (49%, 71%) and 8% (6%, 11%), respectively. Mean GCSI at 1 year post-procedure was significantly lower than pre-procedure; mean difference (MD) (95% CI) -1.4 (-1.9, -0.9). Mean post-procedure distensibility index was significantly higher than pre-procedure in the clinical success group at 40 and 50 mL volume distension; standardised mean difference (95% CI) 0.82 (0.07, 1.64) and 0.91 (0.32, 1.49), respectively. In the clinical failure group, there was no significant difference between mean pre- and post-procedure EndoFLIP measurements. CONCLUSIONS G-POEM is associated with modest clinical success at 1 year. Additional studies with longer follow-up are required to evaluate its longer-term efficacy.
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Affiliation(s)
- Faisal Kamal
- Division of Gastroenterology, University of California-San Francisco, San Francisco, California, USA
| | - Muhammad Ali Khan
- Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Wade Lee-Smith
- Mulford Health Sciences Library, University of Toledo, Toledo, Ohio, USA
| | - Sachit Sharma
- Department of Medicine, University of Toledo, Toledo, Ohio, USA
- Division of Gastroenterology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Ashu Acharya
- Department of Medicine, University of Toledo, Toledo, Ohio, USA
| | - Dawit Jowhar
- Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Umer Farooq
- Department of Medicine, Loyola Medicine/MacNeal Hospital, Berwyn, Illinois, USA
| | - Muhammad Aziz
- Division of Gastroenterology, University of Toledo, Toledo, Ohio, USA
| | - Abdul Kouanda
- Division of Gastroenterology, University of California-San Francisco, San Francisco, California, USA
| | - Sun-Chuan Dai
- Division of Gastroenterology, University of California-San Francisco, San Francisco, California, USA
| | - Colin W Howden
- Division of Gastroenterology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Craig A Munroe
- Division of Gastroenterology, University of California-San Francisco, San Francisco, California, USA
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Gregor L, Wo J, DeWitt J, Yim B, Siwiec R, Nowak T, Mendez M, Gupta A, Dickason D, Stainko S, Al-Haddad M. Gastric peroral endoscopic myotomy for the treatment of refractory gastroparesis: a prospective single-center experience with mid-term follow-up (with video). Gastrointest Endosc 2021; 94:35-44. [PMID: 33373646 DOI: 10.1016/j.gie.2020.12.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/09/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Gastroparesis (GP) is a multifactorial disease associated with a large burden on the health care systems. Pyloric-directed therapies including gastric peroral endoscopic myotomy (G-POEM) can be effective in improving patient quality of life and symptom severity. We report on the safety and efficacy of G-POEM and its impact on the quality of life of patients managed at a large referral center. METHODS Consecutive patients with confirmed GP referred for G-POEM due to failure of medical therapy were included. All patients were assessed at baseline and then at 1, 3, 6, and 12 and 24 months after G-POEM using validated symptom and quality of life instruments, including the Gastroparesis Cardinal Symptom Index (GCSI), Patient Assessment of Gastrointestinal Disorders Symptom Severity Index (PAGI-SYM), and 36-Item Short Form Survey (SF-36). Patients were evaluated before and 6 months after the procedure with EGD, 4-hour scintigraphy, and pyloric EndoFLIP. Technical success was defined as the ability to perform full-thickness pyloromyotomy. Clinical response was defined as an improvement of ≥1 point on GCSI. RESULTS Fifty-two patients (median age, 48 years; range, 25-80 years, 88% female) underwent G-POEM between February 2018 and September 2020 for the following phenotypes: vomiting-predominant (n=30), dyspepsia-predominant (n=16), and regurgitation-predominant (n=6) GP. The technical success rate was 100%. Adverse events were noted in 3 of 52 patients (5.77%), and were all managed successfully endoscopically. Clinical response was achieved in 68%, 58%, and 48% of patients at 1-month, 6-month, and 12-month follow-up (P < .001, P < .001, and P < .01, respectively). When classified by the cause of GP, the clinical response rates were diabetic GP 64% (11 of 17), postsurgical GP 67% (6 of 9), and idiopathic GP 72% (13 of 18). A statistically significant improvement in PAGI-SYM scores was observed at 1, 3, 6, 12, and 24 months, in addition to significant improvement in several domains of SF-36. Mean 4-hour gastric emptying was reduced 6 months after G-POEM (10.2%) compared with baseline (36.5%, P < .001). We report a significant reduction in the number of emergency department visits and days spent in the hospital up to 24 months after G-POEM. CONCLUSIONS G-POEM appears to be a safe and feasible treatment alternative for refractory GP with significant short-term and mid-term improvements in overall symptoms, quality of life scores, and health care utilization.
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Affiliation(s)
- Lennon Gregor
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - John Wo
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - John DeWitt
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Brandon Yim
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Robert Siwiec
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Thomas Nowak
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Martha Mendez
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Anita Gupta
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Destenee Dickason
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Sarah Stainko
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Mohammad Al-Haddad
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Abdelfatah MM, Noll A, Kapil N, Shah R, Li L, Nustas R, Li B, Luo H, Chen H, Xia L, Mekaroonkamol P, Shahnavaz N, Keilin S, Willingham F, Christie J, Cai Q. Long-term Outcome of Gastric Per-Oral Endoscopic Pyloromyotomy in Treatment of Gastroparesis. Clin Gastroenterol Hepatol 2021; 19:816-824. [PMID: 32450364 DOI: 10.1016/j.cgh.2020.05.039] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Gastric per oral endoscopic pyloromyotomy (GPOEM) is a promising treatment for gastroparesis. There are few data on the long-term outcomes of this procedure. We investigated long-term outcomes of GPOEM treatment of patients with refractory gastroparesis. METHODS We conducted a retrospective case-series study of all patients who underwent GPOEM for refractory gastroparesis at a single center (n = 97), from June 2015 through March 2019; 90 patients had more than 3 months follow-up data and were included in our final analysis. We collected data on gastroparesis cardinal symptom index (GCSI) scores (measurements of postprandial fullness or early satiety, nausea and vomiting, and bloating) and SF-36 questionnaire scores (measures quality of life). The primary outcome was clinical response to GPOEM, defined as a decrease of at least 1 point in the average total GCSI score with more than a 25% decrease in at least 2 subscales of cardinal symptoms. Recurrence was defined as a return to baseline GCSI or GCSI scores of 3 or more for at least 2 months after an initial complete response. The secondary outcome was the factors that predict GPOEM failure (no response or gastroparesis recurrence within 6 months). RESULTS At initial follow-up (3 to 6 months after GPOEM), 73 patients (81.1%) had a clinical response and significant increases in SF-36 questionnaire scores (indicating increased quality of life) whereas 17 patients (18.9%) had no response. Six months after GPOEM, 7.1% had recurrence. At 12 months, 8.3% of patients remaining in the study had recurrence. At 24 months, 4.8% of patients remaining in the study had a recurrence. At 36 months, 14.3% of patients remaining in the study had recurrence. For patients who experienced an initial clinical response, the rate of loss of that response per year was 12.9%. In the univariate and multivariate regression analysis, a longer duration of gastroparesis reduced the odds of response to GPOEM (odds ratio [OR], 0.092; 95% CI, 1.04-1.3; P = .001). On multivariate logistic regression, patients with high BMIs had increased odds of GPOEM failure (OR, 1.097; 95% CI, 1.022-1.176; P = .010) and patients receiving psychiatric medications had a higher risk of GPOEM failure (OR, 1.33; 95% CI, 0.110-1.008; P = .052). CONCLUSIONS In retrospective analysis of 90 patients who underwent GPOEM for refractory gastroparesis, 81.1% had a clinical response at initial follow-up of their procedure. 1 year after GPOEM, 69.1% of all patients had a clinical response and 85.2% of initial responders maintained a clinical response. Patients maintained a clinical response and improved quality of life for as long as 3 years after the procedure. High BMI and long duration gastroparesis were associated with failure of GPOEM.
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Affiliation(s)
- Mohamed M Abdelfatah
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - Alan Noll
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - Neil Kapil
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - Rushikesh Shah
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - Lianyong Li
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - Rosemary Nustas
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - Baiwen Li
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - Hui Luo
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - Huimin Chen
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - Liang Xia
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - Parit Mekaroonkamol
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - Nikrad Shahnavaz
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - Steven Keilin
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - Field Willingham
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - Jennifer Christie
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - Qiang Cai
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia.
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Ozgun YM, Oter V, Piskin E, Colakoglu MK, Aydin O, Aksoy E, Dalgic T, Bostanci EB. Treatment Modalities and the Role of Endoscopy for Delayed Gastric Emptying After Whipple Operation: Analysis of 53 Patients. Am Surg 2021; 88:273-279. [PMID: 33517709 DOI: 10.1177/0003134821989037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Delayed gastric emptying (DGE) is one of the most common complications after Whipple surgery. This situation delays postoperative oral food intake and prolongs hospitalization. Postoperative DGE often develops due to complications such as intra-abdominal abscess, collections, and anastomosis leaks, and these are called secondary DGE. The pathogenesis of primary DGE is still unknown, and there are insufficient data in the literature about the treatment. In this study, patients undergoing Whipple operation were examined separately as primary and secondary DGE. We discussed the causes and treatments of these patients, and also we aimed to present the therapeutic effect of endoscopy for primary DGE after the Whipple procedure. METHODS From March 2014 to March 2018, data of 262 patients who underwent the Whipple procedure were collected prospectively. We observed that postoperative DGE developed in 53 (21.7%) patients. We retrospectively divided the patients by etiology into 2 groups as primary and secondary and graded DGE according to the International Study Group of Pancreatic Surgery. We defined patients who did not have secondary causes such as intra-abdominal abscess as primary DGE. Appropriate interventional procedures were performed for patients with secondary causes. We performed endoscopic intervention with therapeutic intent for patients who had primary DGE. RESULTS The overall rate of DGE was 21.7% (n = 53) among 262 patients undergoing the Whipple procedure. It was observed that in 31 (58.5%) of these 53 patients, DGE was developed due to secondary causes. Interventional procedures were performed to these patients when necessary. A total of 22 (41.5%) patients developed primary DGE. Of these, 9 patients were grade A, 7 were grade B, and 6 were grade C. The mean duration of hospitalization for secondary DGE and primary DGE was 20.36 and 28.7 days, respectively. After endoscopic intervention with therapeutic intent to primary DGE patients, we observed that patients tolerated solid meal after 12 hours in grade B and after 26 hours in grade C patients. CONCLUSION Delayed gastric emptying, which is a common complication after Whipple operation and which deteriorates the quality of life and prolongs the duration of hospital stay, should be treated according to the cause. In secondary DGE, treatment modalities must be focused on intra-abdominal causes such as hematoma, collection, and abcess. We suggest that the primary DGE which is unresponsive to medical treatments could be treated endoscopically. After endoscopic intervention, patients with primary DGE can be started oral intake on the same day and discharged more quickly.
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Affiliation(s)
- Yigit Mehmet Ozgun
- Department of Gastroenterological Surgery, 536164Ankara City Hospital, Ankara, Turkey
| | - Volkan Oter
- Department of Gastroenterological Surgery, 536164Ankara City Hospital, Ankara, Turkey
| | - Erol Piskin
- Department of Gastroenterological Surgery, 536164Ankara City Hospital, Ankara, Turkey
| | | | - Osman Aydin
- Department of Gastroenterological Surgery, 536164Ankara City Hospital, Ankara, Turkey
| | - Erol Aksoy
- Department of Gastroenterological Surgery, 536164Ankara City Hospital, Ankara, Turkey
| | - Tahsin Dalgic
- Department of Gastroenterological Surgery, 536164Ankara City Hospital, Ankara, Turkey
| | - Erdal Birol Bostanci
- Department of Gastroenterological Surgery, Ankara City Hospital, Health of Science University, Ankara, Turkey
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30
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Tan J, Shrestha SM, Wei M, Wang P, Shi J, Lu Y, Gao Q, Lu T, Zhou J, Shi R. Feasibility, safety, and long-term efficacy of gastric peroral endoscopic myotomy (G-POEM) for postsurgical gastroparesis: a single-center and retrospective study of a prospective database. Surg Endosc 2020; 35:3459-3470. [PMID: 32880749 PMCID: PMC8195960 DOI: 10.1007/s00464-020-07793-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 07/07/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Postsurgical gastroparesis is recognized as a gastrointestinal dysfunction syndrome following foregut surgery. Gastric peroral endoscopic myotomy (G-POEM) is suggested as a minimally invasive therapy for gastroparesis. But the long-term efficacy and safety of G-POEM in treating postsurgical gastroparesis are rarely explored. METHODS The primary outcomes included the symptomatic improvement based on gastroparesis cardinal symptoms index (GCSI) and the improvement of gastric emptying. The secondary outcomes included the improvement of gastroesophageal reflux symptoms and complications of G-POEM. RESULTS The severity of postsurgical gastroparesis was not associated with the onset time and the course of the disease. G-POEM significantly reduced GCSI throughout the follow-up period (p < 0.0001). For different anastomotic site, a significant improvement of GCSI was found at 6 month post-G-POEM (F4,165 = 74.18, p < 0.0001). Subscale analysis of GCSI showed that nausea/vomiting, post-prandial fullness/early satiety, and bloating were improved significantly at 6-month post-G-POEM (p < 0.0001, respectively). Half-emptying and whole-emptying time were significantly shortened in patients with different anastomotic site post-G-POEM (half-emptying time: F3,174 = 65.44, p < 0.0001; whole-emptying time: F3,174 = 54.85, p < 0.0001). The emptying of ioversol was obviously accelerated after G-POEM. GCSI wasn't related to pyloric length, pyloric diameter, and thickness of pyloric wall. GERDQ was also used to evaluate the clinical efficacy of G-POEM. For each time points, GERDQ didn't differ significantly in patients with different anastomotic site (F4,104 = 0.8075, p = 0.5231). For patients with different anastomotic site, GERDQ was improved significantly at different time points (F4,104 = 59.11, p < 0.0001). The higher the esophageal anastomotic site was, the faster G-POEM improved the symptoms of gastroesophageal reflux. No one required re-hospitalization for any complication. CONCLUSION G-POEM is a minimally invasive therapy with long-term effectiveness and safety in treating postsurgical gastroparesis.
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Affiliation(s)
- Jiacheng Tan
- Department of Gastroenterology, Zhongda Hospital Southeast University, No. 87 Dingjiaqiao, Nanjing, 210009, Jiangsu, China
| | - Sachin Mulmi Shrestha
- Department of Gastroenterology, Zhongda Hospital Southeast University, No. 87 Dingjiaqiao, Nanjing, 210009, Jiangsu, China
| | - Ming Wei
- Department of Gastroenterology, Zhongda Hospital Southeast University, No. 87 Dingjiaqiao, Nanjing, 210009, Jiangsu, China
| | - Panpan Wang
- Department of Gastroenterology, Zhongda Hospital Southeast University, No. 87 Dingjiaqiao, Nanjing, 210009, Jiangsu, China
| | - Jinjun Shi
- Department of Ultrasound, Zhongda Hospital Southeast University, Nanjing, 210009, Jiangsu, China
| | - Yanjia Lu
- Department of Ultrasound, Zhongda Hospital Southeast University, Nanjing, 210009, Jiangsu, China
| | - Qi Gao
- Department of Ultrasound, Zhongda Hospital Southeast University, Nanjing, 210009, Jiangsu, China
| | - Tong Lu
- Department of Radiology, Zhongda Hospital Southeast University, Nanjing, 210009, Jiangsu, China
| | - Jun Zhou
- Medical Division, Yidu Cloud (Beijing) Technology Co., Ltd, Beijing, 100191, China
| | - Ruihua Shi
- Department of Gastroenterology, Zhongda Hospital Southeast University, No. 87 Dingjiaqiao, Nanjing, 210009, Jiangsu, China.
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Monino L, Gonzalez JM, Barthet M, Vitton V. Role of pyloric botulinum injection and endoscopic functional luminal imaging probe in predicting the outcome of gastric peroral endoscopic pyloromyotomy: Why not? Gastrointest Endosc 2020; 92:798-799. [PMID: 32838923 DOI: 10.1016/j.gie.2020.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 04/05/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Laurent Monino
- Department of Hepatogastroenterology, Université catholique de Louvain, Cliniques universitaires Saint-Luc, Brussels, Belgium; Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
| | - Jean-Michel Gonzalez
- Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
| | - Marc Barthet
- Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
| | - Véronique Vitton
- Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France
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Husťak R, Vacková Z, Krajciova J, Janicko M, Buncová M, Kieslichová E, Spicak J, Martínek J. Per-oral endoscopic pyloromyotomy (g-poem) for the treatment of gastroparesis - a pilot single-centre study with mid-term follow-up. Rozhl Chir 2020; 99:116-123. [PMID: 32349495 DOI: 10.33699/pis.2020.99.3.116-123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Endoscopic pyloromyotomy (G-POEM) is an emerging therapeutic method for the treatment of gastroparesis (GP). So far, only limited case-series suggesting its effectivity have been published. The aim of our study was to assess the effectivity of G-POEM in patients with refractory GP. METHODS Consecutive patients with severe and refractory GP were offered the procedure. An abnormal gastric emptying study (GES) was necessary for inclusion. The main outcome was treatment success defined as a decrease of the total GSCI symptom score by at least 40% from baseline at 3, 6, 12 and 24 months. RESULTS G-POEM was performed in 9 patients (5 women, mean age 56.3): 5 post-surgical, 2 diabetic, 1 idiopathic and 1 combined post-surgical and diabetic. The median follow-up was 23M (range 12-31). All procedures were successfully completed. One patient experienced delayed bleeding from gastric ulceration, which was successfully treated endoscopically; all remaining patients recovered uneventfully. Treatment success was achieved in 8/9 patients (88.9%) at 3, 6 and 12M and in 3/4 (75%) at 24M. The mean GSCI decreased from 3.16 to 0.86 (p=0.008), 0.74 (p=0.008), 1.07 (p=0.008) and 1.31 (p=0.11) at 3, 6, 12 and 24M after the procedure. The Quality of Life Index improved from the baseline value of 77 (range 48102) to 113 (86-138, p=0.03) and 96 (50-124, p=0.4) at 12 and 24M. In patients with treatment success, no recurrences have occurred so far. GES improved/normalized in all the patients. CONCLUSION G-POEM was effective in 88.9% of patients with refractory GP and the effect seems to be long-lasting.
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Podboy A, Hwang JH, Nguyen LA, Garcia P, Zikos TA, Kamal A, Triadafilopoulos G, Clarke JO. Gastric per-oral endoscopic myotomy: Current status and future directions. World J Gastroenterol 2019; 25:2581-2590. [PMID: 31210711 PMCID: PMC6558440 DOI: 10.3748/wjg.v25.i21.2581] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/25/2019] [Accepted: 04/29/2019] [Indexed: 02/06/2023] Open
Abstract
Gastroparesis, or symptomatic delayed gastric emptying in the absence of mechanical obstruction, is a challenging and increasingly identified syndrome. Medical options are limited and the only medication approved by the Food and Drug Administration for treatment of gastroparesis is metoclopramide, although other agents are frequently used off label. With this caveat, first-line treatments for gastroparesis include dietary modifications, antiemetics and promotility agents, although these therapies are limited by suboptimal efficacy and significant medication side effects. Treatment of patients that fail first-line treatments represents a significant therapeutic challenge. Recent advances in endoscopic techniques have led to the development of a promising novel endoscopic therapy for gastroparesis via endoscopic pyloromyotomy, also referred to as gastric per-oral endoscopic myotomy or per-oral endoscopic pyloromyotomy. The aim of this article is to review the technical aspects of the per-oral endoscopic myotomy procedure for the treatment of gastroparesis, provide an overview of the currently published literature, and outline potential next directions for the field.
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Affiliation(s)
- Alexander Podboy
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Redwood City, CA 94063, United States
| | - Joo Ha Hwang
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Redwood City, CA 94063, United States
| | - Linda A Nguyen
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Redwood City, CA 94063, United States
| | - Patricia Garcia
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Redwood City, CA 94063, United States
| | - Thomas A Zikos
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Redwood City, CA 94063, United States
| | - Afrin Kamal
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Redwood City, CA 94063, United States
| | - George Triadafilopoulos
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Redwood City, CA 94063, United States
| | - John O Clarke
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Redwood City, CA 94063, United States
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Mekaroonkamol P, Shah R, Cai Q. Outcomes of per oral endoscopic pyloromyotomy in gastroparesis worldwide. World J Gastroenterol 2019; 25:909-922. [PMID: 30833798 PMCID: PMC6397720 DOI: 10.3748/wjg.v25.i8.909] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 01/10/2019] [Accepted: 01/26/2019] [Indexed: 02/06/2023] Open
Abstract
Per oral endoscopic pyloromyotomy (POP), also known as gastric per-oral endoscopic myotomy (GPOEM), is a novel procedure with promising potential for the treatment of gastroparesis. As more data emerge and the procedure is becoming more recognized in clinical practice, its safety and efficacy need to be carefully evaluated. Appropriate patient selection for favorable clinical success prediction after GPOEM also needs additional research. This review aims to systemically summarize the existing data on clinical outcomes of POP. Symptomatologic responses to the procedure, its adverse effects, procedural techniques, and predictive factors of clinical success are also discussed.
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Affiliation(s)
- Parit Mekaroonkamol
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Rushikesh Shah
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Qiang Cai
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA 30322, United States
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Feng Y, Cui M, He Y, Zhao X. [Establishment and clinical application of modified endoscopic freka trelumina placement]. Zhonghua Wei Chang Wai Ke Za Zhi 2019; 22:79-84. [PMID: 30703798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To establish a modified endoscopic Freka Trelumina placement (mEFTP) for modifying or substituting the traditional endoscopic Freka Trelumina placement (EFTP) and to explore the safety and feasibility of mEFTP in patients requiring enteral nutrition and gastrointestinal decompression in general surgery. METHODS A retrospective cohort study was conducted to analyze the clinical data of patients undergoing EFTP or mEFTP at General Surgery Department of 920 Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from January 2016 to January 2018. INCLUSION CRITERIA the function of lower digestive tract was normal; patients who could not eat through mouth or nasogastric tube needed to have enteral nutrition and gastrointestinal decompression; the retention time of Freka Trelumina (FT) was not expected to exceed 2 months. EXCLUSION CRITERIA contraindication for gastroscopy; suspected shock or digestive tract perforation; suspected mental diseases; infectious diseases of digestive tract; thoracoabdominal aortic aneurysm. mEFIP procedure was as follow. FT was inserted into stomach through one side nasal cavity, gastroscope was inserted into stomach cavity, and the front part of FT was clamped with biopsy forceps through biopsy hole. Biopsy forceps and FT were inserted into the pylorus or anastomosis under gastroscope, and they were pushed into the duodenum or output loop. During pushing, the gastroscope did not pass through the duodenum or output loop. The biopsy forceps was released and pushed out, and FT was pushed with biopsy forceps synchronously into the duodenum or output loop more than 5 cm. The foreign body forceps was inserted through the biopsy hole, and the FT tube was held in the stomach and pushed to the duodenum or output loop. The previous steps repeated until the suction cavity reached the pylorus or anastomosis. The gastroscope was exited gently; the guide wire was pulled out slowly. EFTP procedure: foreign body forceps was used to clamp the front part of FT, and gastroscope, foreign body forceps and FT pass the pylorus or anastomosis simultaneously to reach the descendent duodenum or output loop as a whole. The time of catheterization was recorded and position of FT was examined by X-ray within 1 h after catheterization. The success rate of catheterization and morbidity of complications after catheterization were evaluated and compared between the two groups. RESULTS A total of 141 patients were enrolled, 72 in the mEFTP group and 69 in the EFTP group. In mEFTP group, 45 cases were males and 27 were females with an average age of 55.8(37-76) years; 27 cases had normal upper gastrointestinal anatomy (postoperative gastroplegia syndrome due to colon cancer in 17 cases, due to rectal cancer in 10 cases) and 45 had upper gastrointestinal anatomic changes (gastric cancer with pylorus obstruction in 18 cases and anastomotic block after gastroenterostomy in 27 cases). In the EFTP group, 41 were males and 28 were females with an average age of 55.3(36-79) years; 33 cases had normal upper gastrointestinal anatomy (postoperative gastroplegia syndrome due to colon cancer in 20 cases, due to rectal cancer in 13 cases) and 36 had upper gastrointestinal anatomic changes (gastric cancer with pylorus obstruction in 15 cases and anastomotic block after gastroenterostomy in 21 cases). In patients with normal upper digestive tract anatomy, the average catheterization time of mEFTP was (4.9±1.7) minutes which was shorter than (7.6±1.7) minutes of EFTP(t=6.683, P<0.001). In patients of gastric cancer with pyloric obstruction, the average catheterization time of mEFTP was (6.6±1.6) minutes which was shorter than (10.5±2.6) minutes of EFTP (t=4.724, P<0.001). In patients with anastomotic block after gastroenterostomy, the average catheterization time of mEFTP was (11.3±2.5) minutes which was shorter than (15.1±3.5) minutes of EFTP (t=4.513, P<0.001). In patients with normal upper gastrointestinal anatomy, there were no significant differences in the success rate of catheterization and the morbidity of catheterization complication between mEFTP and EFTP (all P>0.05). In patients with upper gastrointestinal anatomic changes, the success rate of catheterization in mEFTP was even higher than that in EFTP, but the difference was not significant [97.8%(41/45) vs. 86.1%(31/36), χ²=2.880, P=0.089]; while the morbidity of catheterization complication in mEFTP was lower than that in EFTP [0 vs. 8.3%(3/36), χ²=3.894, P=0.048]. CONCLUSIONS Whether the upper gastrointestinal anatomy is normal or not, mEFTP presents shorter catheterization time, higher success catheterization rate than EFTP, and is safety. mEFTP can be widely applied to clinical practice for patients requiring enteral nutrition and gastrointestinal decompression.
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Affiliation(s)
- Yankang Feng
- Department of General Surgery, 920th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Kunming 650032, China
| | - Ming Cui
- Department of General Surgery, 920th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Kunming 650032, China
| | - Yun He
- Department of Anesthesiology, 920 Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Kunming 650032, China
| | - Xilong Zhao
- Department of Pathology, 920 Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Kunming 650032, China
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Mekaroonkamol P, Dacha S, Patel V, Li B, Luo H, Shen S, Chen H, Cai Q. Outcomes of Per Oral Endoscopic Pyloromyotomy in the United States. Gastrointest Endosc Clin N Am 2019; 29:151-160. [PMID: 30396525 DOI: 10.1016/j.giec.2018.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Per oral endoscopic pyloromyotomy (POP) has emerged as an endoscopic intervention for refractory gastroparesis. Early experience in the United States showed exciting clinical response rate, reduced gastroparesis symptoms, improved quality of life, and decreased gastric-emptying time during midterm follow-up up to 18 months. One recent study also showed that the number of patient emergency room visits and hospitalizations decreased significantly after POP. The procedure is technically feasible and safe. As more data become available, it is important to identify patients who would benefit most from this novel procedure.
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Affiliation(s)
- Parit Mekaroonkamol
- Division of Digestive Diseases, Emory University School of Medicine, 615 Michael Street, Suite 201, Atlanta, GA 30322, USA
| | - Sunil Dacha
- Division of Digestive Diseases, Emory University School of Medicine, 615 Michael Street, Suite 201, Atlanta, GA 30322, USA
| | - Vaishali Patel
- Division of Digestive Diseases, Emory University School of Medicine, 615 Michael Street, Suite 201, Atlanta, GA 30322, USA
| | - Baiwen Li
- Division of Digestive Diseases, Emory University School of Medicine, 615 Michael Street, Suite 201, Atlanta, GA 30322, USA
| | - Hui Luo
- Division of Digestive Diseases, Emory University School of Medicine, 615 Michael Street, Suite 201, Atlanta, GA 30322, USA
| | - Shanshan Shen
- Division of Digestive Diseases, Emory University School of Medicine, 615 Michael Street, Suite 201, Atlanta, GA 30322, USA
| | - Huimin Chen
- Division of Digestive Diseases, Emory University School of Medicine, 615 Michael Street, Suite 201, Atlanta, GA 30322, USA
| | - Qiang Cai
- Division of Digestive Diseases, Emory University School of Medicine, 615 Michael Street, Suite 201, Atlanta, GA 30322, USA.
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Kim SH, Keum B, Choi HS, Kim ES, Seo YS, Jeen YT, Lee HS, Chun HJ, Um SH, Kim CD, Park S. Self-expandable metal stents in patients with postoperative delayed gastric emptying after distal gastrectomy. World J Gastroenterol 2018; 24:4578-4585. [PMID: 30386107 PMCID: PMC6209569 DOI: 10.3748/wjg.v24.i40.4578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/11/2018] [Accepted: 10/05/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the efficacy and safety of endoscopic stent insertion in patients with delayed gastric emptying after gastrectomy.
METHODS In this study, we prospectively collected data from patients who underwent stent placement for delayed gastric emptying (DGE) after distal gastrectomy between June 2010 and April 2017, at a tertiary referral academic center. Clinical improvement, complications, and consequences after stent insertion were analyzed.
RESULTS Technical success was achieved in all patients (100%). Early symptom improvement was observed in 15 of 20 patients (75%) and clinical success was achieved in all patients. Mean follow-up period was 1178.3 ± 844.1 d and median stent maintenance period was 51 d (range 6-2114 d). During the follow-up period, inserted stents were passed spontaneously per rectum without any complications in 14 of 20 patients (70%). Symptom improvement was maintained after stent placement without the requirement of any additional intervention in 19 of 20 patients (95%).
CONCLUSION Endoscopic stent placement provides prompt relief of obstructive symptoms. Thus, it can be considered an effective and safe salvage technique for post-operative DGE.
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Affiliation(s)
- Seung Han Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul 02841, South Korea
| | - Bora Keum
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul 02841, South Korea
| | - Hyuk Soon Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul 02841, South Korea
| | - Eun Sun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul 02841, South Korea
| | - Yeon Seok Seo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul 02841, South Korea
| | - Yoon Tae Jeen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul 02841, South Korea
| | - Hong Sik Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul 02841, South Korea
| | - Hoon Jai Chun
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul 02841, South Korea
| | - Soon Ho Um
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul 02841, South Korea
| | - Chang Duck Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul 02841, South Korea
| | - Sungsoo Park
- Division of Upper GI Surgery, Department of Surgery, Korea University College of Medicine, Seoul 02841, South Korea
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Abstract
INTRODUCTION Several surgical treatments exist for treatment of gastroparesis, including gastric electrical stimulation, pyloroplasty, and gastrectomy. Division of the pylorus by means of endoscopy, Per-Oral Pyloromyotomy (POP), is a newer, endoluminal therapy that may offer a less invasive, interventional treatment option. METHODS We describe and present a video of our step by step technique for POP using a lesser curvature approach. The following are technical steps to complete the POP procedure from the lesser curve approach. CONCLUSION In our experience, these methods provide promising initial results with low operative risks, although long-term outcomes remain to be determined.
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Affiliation(s)
- Matthew T Allemang
- Section of Surgical Endoscopy, Department of General Surgery, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA.
| | - Andrew T Strong
- Section of Surgical Endoscopy, Department of General Surgery, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA
| | - Ivy N Haskins
- Section of Surgical Endoscopy, Department of General Surgery, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA
| | - John Rodriguez
- Section of Surgical Endoscopy, Department of General Surgery, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA
| | - Jeffrey L Ponsky
- Section of Surgical Endoscopy, Department of General Surgery, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA
| | - Matthew Kroh
- Department of General Surgery, The Cleveland Clinic Foundation- Abu Dhabi, Abu Dhabi, United Arab Emirates
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Dacha S, Mekaroonkamol P, Li L, Shahnavaz N, Sakaria S, Keilin S, Willingham F, Christie J, Cai Q. Outcomes and quality-of-life assessment after gastric per-oral endoscopic pyloromyotomy (with video). Gastrointest Endosc 2017; 86:282-289. [PMID: 28161449 DOI: 10.1016/j.gie.2017.01.031] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 01/13/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM Gastric per-oral endoscopic pyloromyotomy (GPOEM) is emerging as a promising option for the treatment of gastroparesis. This study assessed outcomes and quality of life after GPOEM for gastroparesis, performed in an endoscopy unit at a major tertiary referral center. METHODS We performed a retrospective review of patients who had undergone GPOEM from June 2015 to July 2016. Data were collected from electronic medical records and included patient demographics, endoscopy records, hospitalization records, clinic visits, and electronic messages. Scores for the Short Form 36 (SF36) and Gastroparesis Cardinal Symptom Index (GCSI) were obtained pre-procedure (16 patients), at 1 month (16 patients), at 6 months (13 patients), and at 12 months (6 patients) after the GPOEM procedure was performed. RESULTS Sixteen consecutive patients, 13 women and 3 men (mean age, 44.76 ± 14.8 years), who underwent GPOEM were enrolled. GPOEM was technically successful in all cases. Thirteen of 16 (81%) patients had a significant improvement in the mean GCSI after GPOEM: 3.40 ± 0.50 before the procedure (16 patients) to 1.48 ± 0.95 (P = .0001) at 1 month (16 patients), 1.36 ± 0.9 (P < .01) at 6 months (13 patients), and 1.46 ± 1.4 (P < .01) at 12 months (6 patients) follow-up. Mean duration of the procedure was 49.7 ± 22.1 minutes. Mean myotomy length was 2.94 ± 0.1 cm. Mean length of hospital stay was 2.46 ± 0.7 days. No adverse events occurred with GPOEM. The SF36 questionnaire demonstrated a significant improvement in quality of life in several domains that was sustained through 6-months' follow-up. Mean 4-hour gastric retention on gastric emptying scans decreased from 62.9% ± 24.3% to 17.6% ± 16.7% (P = .007) after GPOEM. CONCLUSIONS GPOEM results in improvement in the overall symptoms of gastroparesis measured by GCSI, objective assessment of improvement in gastric emptying, and improvement in multiple domains on validated quality-of-life inventories in SF36 over a follow-up period of 6 months.
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Affiliation(s)
- Sunil Dacha
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Parit Mekaroonkamol
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lianyong Li
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nikrad Shahnavaz
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sonali Sakaria
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Steven Keilin
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Field Willingham
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jennifer Christie
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Qiang Cai
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
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Xue HB, Fan HZ, Meng XM, Cristofaro S, Mekaroonkamol P, Dacha S, Li LY, Fu XL, Zhan SH, Cai Q. Fluoroscopy-guided gastric peroral endoscopic pyloromyotomy (G-POEM): a more reliable and efficient method for treatment of refractory gastroparesis. Surg Endosc 2017; 31:4617-4624. [PMID: 28409375 DOI: 10.1007/s00464-017-5524-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 03/15/2017] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Prior studies show promising results of the gastric peroral endoscopic pyloromyotomy (G-POEM) procedure for treatment of refractory gastroparesis. One major technical challenge involved in this procedure is identifying the pyloric muscular ring (PMR). The aim of this study is to establish a reliable method for identification of the PMR during G-POEM. METHODS Fluoroscopy-guided G-POEM was performed by placing an endoclip at the 9 to 11'o clock position at the pylorus for identification of PMR. Conventional G-POEM was performed by observation of blue colored mucosa at the pylorus area as an indirect marker for PMR. The degree of the PMR identification was graded into well identified, identified, and not identified based on the appearance of the PMR. Procedure times were accurately documented. Gastroparesis cardinal symptoms index and gastric emptying scintigraphy were evaluated before and after the procedure. RESULTS Fourteen patients were studied, seven underwent fluoroscopy-guided G-POEM, and seven patients underwent conventional G-POEM. All procedures achieved technical success and no adverse events occurred. In the seven patients who underwent fluoroscopy-guided G-POEM, the PMR was well identified in four patients and identified in three patients. In the seven patients who underwent conventional G-POEM, the PMR was identified in four patients and not identified in three patients. The average time to complete the fluoroscopy-guided G-POEM was significantly shorter than that of the conventional G-POEM. CONCLUSIONS Fluoroscopy-guided G-POEM by placement of an endoclip at the pylorus was a reliable and safe method to direct the orientation of the submucosal tunnel, to facilitate the location of the PMR, and to shorten the procedure time.
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Affiliation(s)
- H B Xue
- Division of Digestive Diseases, Emory University, 1365 Clifton Road, B1262, Atlanta, GA, 30322, USA
- Department of Gastroenterology, Renji Hospital, Jiaotong University School of Medicine, Shanghai, China
| | - H Z Fan
- Division of Digestive Diseases, Emory University, 1365 Clifton Road, B1262, Atlanta, GA, 30322, USA
- Department of Gastroenterology, Yichun People's Hospital, Yichun Jiangxi, China
| | - X M Meng
- Division of Digestive Diseases, Emory University, 1365 Clifton Road, B1262, Atlanta, GA, 30322, USA
- Division of Gastroenterology, Second Affiliated Hospital of Baotou Medical School, Baotou, Inner Mongolia, China
| | - S Cristofaro
- Division of Digestive Diseases, Emory University, 1365 Clifton Road, B1262, Atlanta, GA, 30322, USA
| | - P Mekaroonkamol
- Division of Digestive Diseases, Emory University, 1365 Clifton Road, B1262, Atlanta, GA, 30322, USA
| | - S Dacha
- Division of Digestive Diseases, Emory University, 1365 Clifton Road, B1262, Atlanta, GA, 30322, USA
| | - L Y Li
- Division of Digestive Diseases, Emory University, 1365 Clifton Road, B1262, Atlanta, GA, 30322, USA
- Division of Digestive Diseases, PLA 306 Hospital, Beijing, China
| | - X L Fu
- Division of Digestive Diseases, Emory University, 1365 Clifton Road, B1262, Atlanta, GA, 30322, USA
- Division of Digestive Diseases, Anshan Hospital, Anshan, China
| | - S H Zhan
- Division of Digestive Diseases, Emory University, 1365 Clifton Road, B1262, Atlanta, GA, 30322, USA
- Department of Gastroenterology, Qingdao Municipal Hospital, Qingdao, China
| | - Q Cai
- Division of Digestive Diseases, Emory University, 1365 Clifton Road, B1262, Atlanta, GA, 30322, USA.
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Davis BR, Sarosiek I, Bashashati M, Alvarado B, McCallum RW. The Long-Term Efficacy and Safety of Pyloroplasty Combined with Gastric Electrical Stimulation Therapy in Gastroparesis. J Gastrointest Surg 2017; 21:222-227. [PMID: 27896652 DOI: 10.1007/s11605-016-3327-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 11/15/2016] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Gastroparesis is delayed gastric emptying without mechanical obstruction. Symptomatic improvement can be 50-60% with gastric electrical stimulation. To address delayed gastric emptying, pyloroplasty was added. This study examines the long-term efficacy and safety of simultaneous gastric electrical stimulator implantation and pyloroplasty. METHODS In this prospective single-arm trial conducted from 2012 to 2015, 27 [23 females; mean age 43 (22-63)] gastroparesis patients who underwent simultaneous gastric electrical stimulator implantation with Heineke-Mikulicz pyloroplasty were studied. Six (25%) underwent simultaneous robot-assisted pyloroplasty and gastric electrical stimulator implantation. Diagnosis of gastroparesis was based on the 4-h gastric emptying test defined as >60% retention of isotope at 2 h and >10% at 4 h. Total symptom scores assessing severity of nausea, early satiety, bloating, vomiting, post-prandial fullness, and epigastric pain were obtained at baseline and at follow-up visits, ranging from 3 to 38 months (mean: 17). RESULTS Follow-up data from 24 patients were available for analysis. There was 71% improvement in total symptom score on follow-up. Mean retention decreased by 29.6 and 48.7% at 2 and 4 h and gastric emptying was normalized in 60%. There were no post-surgical complications. CONCLUSIONS Combination of gastric electrical stimulator and pyloroplasty significantly accelerated gastric emptying and improved gastroparesis symptoms. Combining these two surgical therapies improves both subjective and objective endpoints in drug refractory gastroparesis.
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Affiliation(s)
- Brian R Davis
- Department of Surgery, Texas Tech University Health Sciences Center El Paso, 4800 Alberta Ave, El Paso, TX, 79905, USA.
| | - Irene Sarosiek
- Department of Internal Medicine, Division of Gastroenterology, Texas Tech University Health Sciences Center El Paso, 4800 Alberta Ave, El Paso, TX, 79905, USA
| | - Mohammad Bashashati
- Department of Internal Medicine, Division of Gastroenterology, Texas Tech University Health Sciences Center El Paso, 4800 Alberta Ave, El Paso, TX, 79905, USA
| | - Ben Alvarado
- Department of Internal Medicine, Division of Gastroenterology, Texas Tech University Health Sciences Center El Paso, 4800 Alberta Ave, El Paso, TX, 79905, USA
| | - Richard W McCallum
- Department of Internal Medicine, Division of Gastroenterology, Texas Tech University Health Sciences Center El Paso, 4800 Alberta Ave, El Paso, TX, 79905, USA
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Bapaye A, Mahadik M, Pujari R, Vyas V, Dubale N. Per-oral endoscopic pyloromyotomy and per-oral endoscopic myotomy for coexisting refractory gastroparesis and recurrent achalasia cardia in a single patient. Gastrointest Endosc 2016; 84:734-5. [PMID: 27090287 DOI: 10.1016/j.gie.2016.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 04/07/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Amol Bapaye
- Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Mahesh Mahadik
- Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Rajendra Pujari
- Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Viral Vyas
- Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Nachiket Dubale
- Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India
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Abstract
Using traditional techniques in novel ways often can improve management of common surgical problems. Additionally, established products may find new utility when deployed in a slightly different fashion to enhance patient care in a clinically relevant way. This article describes endoscopic placement of radiopaque markers into the proximal small intestine as a means to evaluate motility in a focused fashion. A method to delineate the location of dysmotility in a patient with several potential sites is described. This technique is safe, feasible, reasonably inexpensive, and is easily performed by a skilled endoscopist. Moreover, this technique has the added benefit of providing functional data in a timely fashion.
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Affiliation(s)
- Patricia L Turner
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA.
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Smith A, Cacchione R, Miller E, McElmurray L, Allen R, Stocker A, Abell TL, Hughes MG. Mini-laparotomy with Adjunctive Care versus Laparoscopy for Placement of Gastric Electrical Stimulation. Am Surg 2016; 82:337-342. [PMID: 27097627 PMCID: PMC5089060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We compared outcomes for two gastric electrical stimulation placement strategies, minilaparotomy with adjunctive care (MLAC) versus laparoscopy without adjunctive care (LAPA). For electrode placement, the peritoneal cavity was accessed with either a single 2.5 to 3.0 cm midline incision (MLAC) or three trocar incisions (LAPA). For both groups, generator was placed subcutaneously over the anterior rectus sheath. For MLAC, adjunctive pain control measures were used for placement of both electrode and generator (transversus abdominus plane block). For LAPA, those that could not be completed by laparoscopy were converted to traditional open approach and kept in the analysis. MLAC (n = 128) resulted in shorter operative times than LAPA (n = 37) (median operative time: 87.5 vs 137.0 minutes, P ≤ 0.01). Hospital length of stay was also shorter for MLAC than for LAPA (median: 2.0 vs 3.0 days, P ≤ 0.01) without any increase in readmission rates to the hospital within 30 days of discharge (11.0 vs 16.2%, P = 0.39). After equalizing learning curves, these differences were even greater (median operative time: 84.5 vs 137.0 minutes, P < 0.01; median length of stay: 1.0 vs 3.0 days; P < 0.01) without increasing 30-day readmission rates (9.1 vs 16.2%, P = 0.25). For implantation of gastric electrical stimulators, minilaparotomy can result in improved outcomes when coupled with adjunctive pain control measures.
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Affiliation(s)
- Alison Smith
- Department of Medicine, School of Medicine, University of Louisville, Louisville, Kentucky, USA
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Abstract
BACKGROUND A difficult management problem for the upper gastrointestinal surgeon exists when a patient presents with symptomatic and refractory severe delayed gastric emptying. Surgical treatment is further complicated by coexisting gastro-oesophageal reflux. No universal surgical strategy exists for this problem. METHODS A novel surgical strategy combines partial sleeve gastrectomy (SG) and hiatus hernia (HH) repair with fundoplication. A review of treating four such patients is described with objective outcome data. RESULTS Overall, solid gastric emptying improved in all, from median 350 (163-488) min pre-operatively to 108 (84-135) at 10 months (3-24) post-operatively, corresponding to 67% improvement. Primary symptoms resolved in all; however, one patient had recurrent symptoms. GERD-HRQL also improved in all, from median 23 (3-25) to 4 (0-8) at 21 months (6-30, 83% improvement). Gas bloat improved in three. All had post-operative gastroscopies showing intact repair and absent oesophagitis, with no patient requiring post-operative PPI. Patient weight reduced by median 11% (7-20) post-operatively. There was no significant peri-operative morbidity. CONCLUSIONS With careful patient selection and work-up, SG and HH repair with fundoplication may improve quality of life by coupling adequate reflux control with improved gastric emptying.
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Affiliation(s)
- Philip A Le Page
- Department of Surgery, Concord and Repatriation Hospitals, Hospital Road, Concord, NSW, 2139, Australia,
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Huang MQ, Li M, Mao JY, Tian BL. Braun enteroenterostomy reduces delayed gastric emptying: A systematic review and meta-analysis. Int J Surg 2015; 23:75-81. [PMID: 26384836 DOI: 10.1016/j.ijsu.2015.09.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 08/26/2015] [Accepted: 09/07/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND It remains controversial whether the additional Braun enteroenterostomy (BEE) is necessary in decreasing delayed gastric emptying (DGE) following pancreaticoduodenectomy (PD). This meta-analysis aims to assess the efficacy of the additional BEE in reducing DGE after PD. METHODS PubMed, EMBASE, Science Citation Index and The Cochrane Library were searched to identify relevant studies. Articles published before May 15, 2015 comparing BEE with traditional gastrojejunostomy during PD were selected. The evaluated end points consist of intro-operative outcomes as well as postoperative complications. RESULTS Seven observational clinical studies that recruited 1401 patients were included. This meta-analysis indicated that the occurrence of DGE was lower in Braun group (odds ratio [OR], 0.30; 95% confidence interval [CI], 0.15 to 0.60; P = 0.0007). Overall morbidity (OR, 0.61; 95%CI, 0.47 to 0.80; P = 0.0003) and the length of hospital stay (LOS) (weighted mean difference [WMD], -1.80; 95%CI, -3.4 to -0.18; p = 0.03) were also in favor of the Braun group. However, Braun group had no advantage over Non-Braun group in terms of intra-operative blood loss, mortality, pancreatic fistula, bile Leakage and intra-abdominal abscess. CONCLUSION The additional of BEE plays an important role in reducing DGE, overall morbidity and LOS.
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Affiliation(s)
- Ming-quan Huang
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Mou Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jing-yu Mao
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Bo-le Tian
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
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Mancini SA, Angelo JL, Peckler Z, Philp FH, Farah KF. Pyloroplasty for Refractory Gastroparesis. Am Surg 2015; 81:738-746. [PMID: 26140897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Gastroparesis is a chronic gastric motility disorder in which the pathophysiology mimics a postvagotomy state. Pyloroplasty is beginning to emerge as a successful drainage procedure for refractory gastroparesis. Here we report our experience using pyloroplasty in the surgical management of diabetic and nondiabetic gastroparesis. A retrospective study was performed of 46 patients undergoing pyloroplasty for refractory gastroparesis from January 2010 through December 2013. Gastric emptying scintigraphy and the Gastroparesis Cardinal Symptom Index were assessed pre- and postoperatively. Laparoscopic pyloroplasty was performed in 42 patients, open pyloroplasty in three, and one patient was converted from laparoscopic to open pyloroplasty. Studies were repeated during the six to 12 month postoperative interval. The postoperative gastric emptying scintigraphy improved in 90 per cent of patients and normalized in 60 per cent. Postoperative T½ was significantly reduced (P = 0.001) as was four-hour retention (P < 0.001). The Gastroparesis Cardinal Symptom Index showed statistically significant reduction in symptom severity for all nine categories (P < 0.0005) as well as total symptom score (P < 0.005). No patients developed dumping syndrome. Pyloroplasty is a highly effective therapy for refractory gastroparesis, offering significant reduction in symptom severity, improvement in quality of life, and acceleration of gastric emptying.
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Affiliation(s)
- Sheri A Mancini
- Department of Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
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Otsuka R, Natsume T, Maruyama T, Tanaka H, Matsuzaki H. Antecolic reconstruction is a predictor of the occurrence of roux stasis syndrome after distal gastrectomy. J Gastrointest Surg 2015; 19:821-4. [PMID: 25693423 DOI: 10.1007/s11605-015-2770-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 02/02/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Roux-en-Y reconstruction after distal gastrectomy can result in delayed gastric emptying, called Roux stasis syndrome (RSS). The cause of RSS has not been completely identified. This study retrospectively investigated the development of RSS. METHODS Between April 2008 and March 2014, we performed 138 procedures with distal gastrectomy using Roux-en-Y reconstruction. The development of RSS was analyzed and examined for correlations with the length of the operation, amount of blood loss, and surgical procedure. RESULTS RSS was observed in 16 of the 138 patients. There were no relationships between the length of the operation or amount of blood loss and the development of RSS according to the Mann-Whitney U test. There were also no significant differences in the development of RSS between the patients treated with laparotomy and laparoscopic surgery, end-to-side, side-to-side, or end-to-end anastomosis or isoperistaltic or antiperistaltic anastomosis, as determined using the chi-square test. However, the development of RSS tended to lower in the patients who underwent laparoscopic surgery, side-to-side anastomosis, and isoperistaltic anastomosis. In addition, there was a significant difference between the patients who received antecolic and retrocolic reconstruction (p=0.005). CONCLUSIONS Our findings suggest that antecolic reconstruction correlates with a lower likelihood of developing RSS.
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Affiliation(s)
- Ryota Otsuka
- Department of Surgery, Funabashi Municipal Medical Center, 1-21-1, Kanasugi, Funabashi-shi, Chiba, 273-8588, Japan,
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Inside gastroparesis. Understanding and coping with a serious stomach disorder. Johns Hopkins Med Lett Health After 50 2014; 26:3. [PMID: 25300071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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50
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Discussion. J Am Coll Surg 2014; 218:660-2. [PMID: 24655854 DOI: 10.1016/j.jamcollsurg.2014.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 01/17/2014] [Indexed: 11/17/2022]
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