The addition of pyloroplasty as a new surgical approach to enhance effectiveness of gastric electrical stimulation therapy in patients with gastroparesis
Article first published online: 31 OCT 2012
© 2012 Blackwell Publishing Ltd
Neurogastroenterology & Motility
Volume 25, Issue 2, pages 134–e80, February 2013
How to Cite
Sarosiek, I., Forster, J., Lin, Z., Cherry, S., Sarosiek, J. and McCallum, R. (2013), The addition of pyloroplasty as a new surgical approach to enhance effectiveness of gastric electrical stimulation therapy in patients with gastroparesis. Neurogastroenterology & Motility, 25: 134–e80. doi: 10.1111/nmo.12032
- Issue published online: 22 JAN 2013
- Article first published online: 31 OCT 2012
- Received: 9 April 2012 Accepted for publication: 23 August 2012
- gastric electrical stimulation;
Background Improvement of gastroparesis (GP) symptoms has been documented in patients treated with gastric electrical stimulation (GES), but acceleration of gastric emptying (GET) is unpredictable. The aim of our study was to evaluate the advantage of adding surgical pyloroplasty (PP) to GES for improvement of GET and control of symptoms in diabetes mellitus (DM), idiopathic (ID), and postvagotomy (P-V) GP.
Methods A total of 49 (17 – DM, 9 – ID, 23 – P-V) consecutive GP patients: 38 female; mean age 42 (21–73 years); mean weight 158 lbs (102–245), underwent GES implantation, and 26 (53%) additionally received PP. Total Symptoms Score, 4-h GET, adverse events (AEs), and days of hospitalizations were captured at baseline and at the last visit.
Key Results The mean follow-up was 7 months. Total Symptoms Score in patients who received Enterra and PP or GES alone significantly improved compared to their baseline scores (P < 0.001). GET improved by 64% at 4 h (P < 0.001) in patients with Enterra and PP, compared to 7% observed after GES therapy alone (ns). The most impressive acceleration of GET was seen in the P-V group, who received both therapies (P = 0.004) and 8 (60%) of them normalized GET. No AEs accompanied the addition of PP to the Enterra surgery.
Conclusions & Inferences (i) In drug-refractory GP the addition of PP to GES substantially accelerated GET; (ii) The GET response in P-V group was the most impressive; (iii) Significant symptom reductions were achieved by both procedures; and (iv) PP added to GES may sustain better long-term symptoms control particularly in the P-V setting.