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Laparoscopic pyloroplasty versus endoscopic per-oral pyloromyotomy for the treatment of gastroparesis

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Abstract

Background

Gastroparesis is a debilitating functional disorder of the stomach characterized by delayed gastric emptying absent an obstructive etiology. Surgical or endoscopic disruption of the pylorus has been utilized to treat this disease, but there is little evidence comparing laparoscopic pyloroplasty (LP) with endoscopic per-oral pyloromyotomy (POP). Herein we describe our experience at our institution using a propensity-matched cohort study to compare outcomes between these procedures.

Methods

All patients who underwent LP for the treatment of gastroparesis from October 2014 through September 2017 at our institution were retrospectively reviewed. Propensity scoring was used to match these patients 1:1 to patients undergoing POP during this time period based on gender, age, and etiology of gastroparesis. Symptom scores using the Gastroparesis Cardinal Symptom Index (GCSI), scintigraphic gastric emptying studies (GES), and perioperative outcomes were compared between matched cohorts. Thirty patients underwent LP for gastroparesis during the study period which were matched 1:1 with patients undergoing POP. The etiology of gastroparesis was 63.3% idiopathic (n = 19), 20.0% post-surgical (n = 6), and 16.7% diabetic (n = 5) in both cohorts.

Results

Patients who underwent LP had a longer average length of stay (4.6 vs. 1.4 days, p = 0.003), operative time (99.3 vs. 33.9 min, p < 0.001), and estimated blood loss (12.9 vs. 0.4 mL, p < 0.001). There were more complications in the LP cohort (16.7 vs. 3.3%, p = 0.086), which included surgical site infection (6.7 vs. 0%, p = 0.153), pneumonia (6.7 vs. 0.0%, p = 0.153), and unplanned ICU admission (10.0 vs. 0.0%, p = 0.078). LP and POP both resulted in similar, significant improvements in both in GCSI scores and objective gastric emptying.

Conclusions

Per-oral endoscopic pyloromyotomy (POP) is safe and effective for the treatment of medical refractory gastroparesis. POP has less perioperative morbidity compared to LP with comparative functional outcomes.

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Authors and Affiliations

  1. Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA

    Joshua P. Landreneau, Andrew T. Strong, Kevin El-Hayek, James Villamere, Jeffrey L. Ponsky, Matthew D. Kroh & John H. Rodriguez

  2. Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA

    Andrew T. Strong, Kevin El-Hayek, Jeffrey L. Ponsky, Matthew D. Kroh & John H. Rodriguez

  3. Cleveland Clinic Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

    Chao Tu

  4. Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates

    Matthew D. Kroh

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  1. Joshua P. Landreneau
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Correspondence to Joshua P. Landreneau.

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Disclosures

Matthew D. Kroh has no conflict of interest relevant to this publication. Outside of the scope of this work, he serves as a consultant for Levita Magnetics and Medtronic. He has received research funding from Cook. John H. Rodriguez has no conflict of interest relevant to this publication. Outside of the scope of this publication, he has received research funding from Pacira Pharmaceuticals and Intuitive Surgical. Joshua Landreneau, Andrew Strong, Kevin El-Hayek, Chao Tu, James Villamere, and Jeffrey Ponsky have no conflict of interest or financial ties to disclose.

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Landreneau, J.P., Strong, A.T., El-Hayek, K. et al. Laparoscopic pyloroplasty versus endoscopic per-oral pyloromyotomy for the treatment of gastroparesis. Surg Endosc 33, 773–781 (2019). https://doi.org/10.1007/s00464-018-6342-6

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  • DOI: https://doi.org/10.1007/s00464-018-6342-6

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