19-YEAR PROCEDURAL TRENDS IN THE MANAGEMENT OF GASTROPARESIS IN THE STATE OF NEW YORK
Kelly Ieong*1, Talar Tatarian4, Lizhou Nie2, Jie Yang3, Konstantinos Spaniolas4, Aurora D. Pryor4
1Stony Brook School of Medicine, Stony Brook, NY; 2Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY; 3Department of Family, Population and Preventive Medicine, Stony Brook University Medical Center, Stony Brook, NY; 4Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Stony Brook University Medical Center, Stony Brook, NY
Introduction: Gastroparesis inpatient admissions and healthcare utilization have increased significantly over the years. However, data on surgical management of gastroparesis remain sparse. This study aims to assess procedural trends and reintervention rates of each procedure type in patients with gastroparesis in New York State.
Methods: New York State Planning and Research Cooperative System (SPARCS) longitudinal administrative data were used to identify 12,190 adult patients with primary diagnosis of gastroparesis from 1995 to 2013. Follow-up records were analyzed to identify procedures performed. Procedures included enteral tubes (gastrostomy and jejunostomy), botox injections, endoscopic pyloroplasty dilation, pyloroplasty and pyloromyotomy, gastric electric stimulator, gastrectomy, and bariatric surgery (sleeve gastrectomy and Roux-en-y gastric bypass). Patients requiring reintervention within 2 years following their first procedure were tracked. Marginal trend analysis was performed using Type-3 Chi Square test from simple Poisson regression.
Results: Of the 12,190 patients with a primary diagnosis of gastroparesis, 2,613 overall procedures were performed. A decreasing trend is observed for enteral tubes and an increasing trend is observed for Botox injections performed (RR = 0.96 vs RR = 1.12, p<0.0001). The 2-year reintervention rates were highest for Botox injections (38.5%), endoscopic dilations (32.7%) and enteric tubes (19.5%) and lowest for gastrectomy (9%) and bariatric surgery (11.8%) (p<0.0001). Mean interval between first intervention and reintervention was shortest for Botox injections (416 days), endoscopic dilations (543 days) and enteral tubes (556 days).
Conclusions: In New York State, there is an overall increase in gastroparesis interventions over the years. Botox injections, endoscopic dilations and enteral tubes are the most common procedures performed in patients with gastroparesis. However, these procedures have the highest reintervention rates and the shortest duration to reintervention. This study prompts further investigation on the cost-effectiveness of indicated procedures in the management of gastroparesis.
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