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SIMULTANEOUSLY ADDRESSING GASTROPARESIS AND SLOW TRANSIT CONSTIPATION - WHAT TO DO WHEN TWO ORGANS DO NOT FUNCTION?
Hana Fayazzadeh*1, Andrew T. Strong1,2, John Rodriguez1,2, Kevin M. El-Hayek1,2
1General Surgery-Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH; 2Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
Introduction: Endoscopic or surgical interventions are indicated for medically refractory gastroparesis (GP). With the advent of novel diagnostic tools, such as wireless motility capsule, other dysmotility syndromes such as slow transit constipation (STC) are being discovered in patients with GP. Currently there are no guidelines regarding address both GP and STC simultaneously. We present three such cases, and propose a possible algorithm for management.
Methods: A prospectively managed database of patients with medically refractory gastroparesis was queried to identify patients who also underwent surgical management of STC. Demographics, operative approach and post-operative outcomes were analyzed.
Results: We identified 3 female patients with both medically refractory GP and STC. Presenting complaints included postparandial abdominal discomfort, nausea, bloating, and severe constipation. All patients underwent upper and lower gastrointestinal endoscopy, gastric emptying study, and wireless motility capsule studies preoperatively to confirm both diagnoses. Based on multidisciplinary decision, all patients underwent endoscopic per-oral pyloromyotomy (POP) and laparoscopic diverting loop ileostomy (DLI). Patient characteristics as well as surgical specifications and postoperative outcomes are summarized in the Table. All patients had objective improvement in gastric emptying by scintigraphic emptying studies. Patients' STC-related symptoms subjectively improved with DLI.
Conclusion: Patients with combined medically refractory GP and STC are complex and require a multidisciplinary team-based approach. Addressing both GP via POP and performing a DLI may improve symptoms of both motility disorders and may better predict those who may benefit from a more invasive large bowel resection.
| | Gender | Age (years) | Cause of Gastroparesis | Comorbidities | Colectomy performed | Other surgical interventions | | Case 1 | Female | 65 | Post-surgical | Hypertension and COPD | No | No | | Case 2 | Female | 56 | Idiopathic | None | No | Reversal of DLI | | Case 3 | Female | 44 | Idiopathic | None | Yes | Reversal of DLI |
Abbreviations: COPD, chronic obstructive pulmonary disease; DLI, diverting loop ileostomy
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