|
Back to 2016 Annual Meeting
the Long-Term Efficacy and Safety of Pyloroplasty Combined With Gastric Electrical Stimulation: A Single Academic Center Experience
Brian R. Davis*1, Mohammad Bashashati2, Ben Alvarado2, Richard W. McCallum2, Irene Sarosiek2
1Surgery, Texas Tech University Health Sciences Center, El Paso, TX; 2Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX
Introduction: Gastroparesis (GP), defined as delayed gastric emptying without any mechanical obstruction affects up to 10 million individuals in the United States. Improvement of symptoms is achieved in up to 50-60% of these patients treated with gastric electrical stimulation (GES), but this therapy has minimal or no effect on the acceleration of gastric emptying (GE). To address this therapeutic deficiency, we have added surgical pyloroplasty (PP) as a supplementary procedure to accelerate GE in drug refractory gastroparetics undergoing implantation of GES. The current study was designed to assess the long-term efficacy and safety of combined GES implantation and PP in GP patients who were referred to our clinic from September 2012 to June 2015.
Methods: Twenty-seven [23 females; mean age 43 years old (23-63); mean weight 148 lbs. (86-245)] drug-refractory GP patients who underwent surgical implantation of the GES together with the Heineke-Mikulicz PP during the study period. There were 17 diabetic (DM) and 10 idiopathics (IP). The diagnosis of GP was based on the standardized isotope labeled egg-beater 4-hrs GE test and was defined as > 60% retention of isotope at 2 hrs and >10% at 4 hrs. Total GP symptoms scores (TSS) assessing severity of nausea, early satiety, bloating, vomiting, postprandial fullness and epigastric pain were obtained by using a 5-point Likert scale (0 to 4) at baseline and the last follow-up visits, ranging from 3 to 38 months (mean: 17 months) post-op. The GE test was also repeated at the follow-up visits. Data is presented as mean ±SD at each time-point or % of changes in the follow-up compared to the baseline.
Results: Post-op data from 24 patients were available for paired analysis, while 3 patients died from complications of their comorbidities 3, 5 and 14 months after surgery. Six (25%) underwent simultaneous robotic-assisted pyloroplasty and GES implantation. There was 71% improvement in TSS in the follow-up evaluation. The statistically significant improvement of the symptoms was still observed when we categorized the patients into IP and DM subgroups. After surgery, the mean retention of the radiolabeled meal decreased by 29.6% and 48.7% at 2 and 4-hrs, respectively and GE was normalized in 60 % of GP patients. There were no post-surgical complications or technical problems related to combining PP with GES.
Conclusions: In drug-refractory GP, the combination of PP and GES significantly accelerated gastric emptying and improved GP symptoms exceeding the results previously achieved by GES alone. By combining PP and GES, both subjective and objective goals of improvement were successfully achieved in drug refractory gastroparesis.
The severity of upper gastrointestinal symptoms in gastroparetic patients at baseline and after surgery
| | Nausea | Vomiting | Early Satiety | Bloating | Post-Prandial Fullness | Epigastric Pain | Epigastric Burning | | Pre-Op* | 3.6
(0.4) | 3.2
(1.2) | 3.2
(0.7) | 2.5
(1.3) | 2.8
(0.9) | 2.7
(1.4) | 2.0
(1.8) | | Post-Op | 1.1
(1.1) | 0.6
(1.0) | 0.9
(1.0) | 0.9
(1.2) | 1.0
(1.1) | 1.0
(1.5) | 0.9
(1.5) | | Wilcoxon-rank test (p-value) | 0.0001 | 0.0002 | 0.0001 | 0.001 | 0.0004 | 0.0004 | Not Significant |
*data represents mean (standard deviation)
Back to 2016 Annual Meeting
|
