Patient factors influence surgical options in gastroparesis

Background: Patient selection for the diverse surgical procedures for gastroparesis remains poorly defined. Our aim was to evaluate how patient factors have determined our surgical approach to gastroparesis. Methods: 95 patients undergoing 105 surgical procedures for gastroparesis were reviewed. Patient factors were compared across six surgical procedures: gastric neurostimulator, pyloroplasty, neurostimulator plus pyloroplasty, sleeve gastrectomy, gastric bypass and gastrectomy. Global symptom severity was determined preoperatively and at last follow up. Results: There were significant differences in etiology, BMI and gastroesophageal reflux across the various operations. Patients undergoing pyloroplasty and gastrectomy; were more likely to have a postsurgical etiology. (p <.05) Patients undergoing sleeve gastrectomy and gastric bypass were more likely to have BMI >35. ^{(p <.05)} Those undergoing sleeve gastrectomy were less likely to have gastroesophageal reflux preoperatively. ^{(p <.05)} There was no difference in preoperative clinical stage across the procedures. Conclusion: Patient factors influence choice of procedure in the surgical treatment of gastroparesis. Etiology of gastroparesis, BMI >35 and gastroesophageal reflux are important determinants.