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

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

Research output: Contribution to journalArticlepeer-review

53 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)5381-5388
Number of pages8
JournalSurgical endoscopy
Volume31
Issue number12
DOIs
StatePublished - Dec 1 2017
Externally publishedYes

Keywords

  • Endoscopy
  • Gastroparesis
  • Pyloromyotomy

ASJC Scopus subject areas

  • Surgery

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