Image: A simple endoscopic approach helps relieve gastroparesis (Photo courtesy of the Cleveland Clinic).
Per-oral pyloromyotomy (POP), an endoscopic intramural treatment for gastroparesis, significantly improves patient symptoms and gastric emptying, according to a new study.
Researchers at the Cleveland Clinic (CC; OH, USA) and Case Western Reserve University (CWRU; Cleveland, OH, USA) conducted a retrospective study to compare all 30 patients who underwent laparoscopic pyloroplasty (LP) for treatment of gastroparesis with those undergoing POP from October 2014 through September 2017. Patients were matched on a 1:1 basis, based on gender, age, and etiology of gastroparesis, which was 63.3% idiopathic, 20.0% post-surgical, and 16.7% diabetic (in both cohorts).
The results revealed that patients who underwent LP had an almost triple average length of stay and estimated blood loss than those that underwent POP. There were more overall complications in the LP cohort than in the POP one (16.7 versus. 3.3%, respectively), including surgical site infection (6.7 versus 0%), pneumonia (6.7% versus 0%), and unplanned ICU admission (10% versus 0%). LP and POP both resulted in similar, significant improvements in both in gastroparesis cardinal symptom index (GCSI) scores and objective gastric emptying. The study was published on July 17, 2018, in Surgical Endoscopy.
“When you compare the results in terms of symptom improvement and the complication rate of this as a new procedure, we’re doing much better than every other option that we have for patients with gastroparesis,” said senior author John Rodriguez, MD, director of surgical endoscopy at the Cleveland Clinic. “The procedure is very safe, and there were no procedure-related adverse events, including gastric or duodenal ulcer, intraluminal hemorrhage, or gastric dumping syndrome.”
Gastroparesis, a delayed gastric emptying in the absence of mechanical obstruction, is a debilitating and chronic digestive disease affecting five million people in the U.S. alone. Surgical options are few: gastric electrical stimulation, gastric emptying procedures, gastric diversion or gastric resection. POP is a less invasive method of disrupting the pylorus; the technique involves an initial mucosotomy to create a submucosal tunnel up to the duodenal bulb, followed by a myotomy of the circular fibers of the pylorus. The mucosotomy is subsequently closed with clips.
Case Western Reserve University