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01-12-2017

Per oral endoscopic pyloromyotomy for refractory gastroparesis: initial results from a single institution

Authors: John H. Rodriguez, Ivy N. Haskins, Andrew T. Strong, Ryan L. Plescia, Matthew T. Allemang, Robert S. Butler, Michael S. Cline, Kevin El-Hayek, Jeffrey L. Ponsky, Matthew D. Kroh

Published in: Surgical Endoscopy | Issue 12/2017

Abstract

Introduction

Gastroparesis is a debilitating disease characterized by delayed gastric emptying in the absence of mechanical obstruction. A new intramural technique, per oral endoscopic pyloromyotomy (POP), has been proposed as an alternative to surgical pyloroplasty for the management of medical refractory gastroparesis. Herein, we detail the short-term results of POP at our institution.

Methods

POP was first performed at our institution in January 2016. All patients undergoing POP for management of gastroparesis from January 2016 through January 2017 were prospectively followed. All patients underwent a 4-h, non-extrapolated gastric emptying scintigraphy study and were asked to rate their symptoms using the Gastroparesis Cardinal Symptom Index (GCSI) at their pre-procedure visit and at 3 months post-procedure.

Results

A total of 47 patients underwent POP during the defined study period. Twenty-seven (57.4%) patients had idiopathic gastroparesis, 12 (25.6%) had diabetic gastroparesis, and eight (17.0%) had post-surgical gastroparesis. Forty-one (87.2%) patients had at least one previous intervention (i.e., enteral feeding tube, gastric pacer, botox injection) for their gastroparesis symptoms. All patients had evidence of gastroparesis on pre-procedure gastric emptying studies. The average length of hospital stay was 1 day. One patient died within 30-days of their index procedure which was unrelated to the procedure itself. The average pre-procedure percentage of retained food at 4 h was 37% compared to an average post-procedure percentage of 20% (p < 0.03). The average pre-procedure GCSI score was 4.6 compared to an average post-procedure GCSI of 3.3 (p < 0.001).

Conclusions

POP is a safe and feasible endoscopic intervention for medical refractory gastroparesis. Additional follow-up is required to determine the long-term success of this approach in alleviating gastroparesis symptoms.

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Title: Per oral endoscopic pyloromyotomy for refractory gastroparesis: initial results from a single institution
Authors: John H. Rodriguez
Ivy N. Haskins
Andrew T. Strong
Ryan L. Plescia
Matthew T. Allemang
Robert S. Butler
Michael S. Cline
Kevin El-Hayek
Jeffrey L. Ponsky
Matthew D. Kroh
Publication date: 01-12-2017
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 12/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-017-5619-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Per oral endoscopic pyloromyotomy for refractory gastroparesis: initial results from a single institution

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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