SURGICAL PYLOROPLASTY: A NEGATIVE PREDICTOR FOR CLINICAL IMPROVEMENT AFTER ENDOSCOPIC PER-ORAL PYLOROMYOTOMY (POP) FOR POST-SURGICAL GASTROPARESIS
Gregory Dean, Kevin Liu*, Ezra Teitelbaum, Eric S. Hungness, Nathaniel J. Soper, John E. Pandolfino, A. Aziz Aadam
Northwestern University, Chicago, IL
Background:
Post-surgical gastroparesis (PSG) is a complex disorder that can occur after foregut surgery due to intentional or inadvertent vagotomy, resulting in loss of parasympathetic stimulation to the stomach and pylorus. Pyloroplasty is commonly performed during esophagectomy to improve post-operative gastric emptying. Recently, POP has been shown to be an effective endoscopic therapy for refractory gastroparesis. The impact of prior pyloroplasty on clinical outcomes for PSG after POP remains to be determined.
Aims:
To evaluate clinical outcomes of patients undergoing POP for PSG with or without prior history of surgical pyloroplasty.
Methods:
We performed a single-center retrospective study of patients who underwent POP for PSG from 2017-2019. Patients were stratified into two groups based on whether they had a prior history of pyloroplasty before POP for PSG. Primary outcomes included symptom response as measured by the Gastroparesis Cardinal Symptom Index (GCSI) pre and post-POP, and gastric emptying study (GES) results pre-POP and 3 months post-POP. Prior surgical history characteristics and procedural data of POP were also assessed.
Results:
Nineteen patients underwent POP for PSG. Patients had a mean of 2.6±1.0 foregut surgeries prior to referral for POP. Esophagectomy was the predominant surgery accounting for PSG found in 11 (58%) patients with mean time of 75.2±79.6 months before POP. Technical success of POP was 100% with 1 intra-procedural adverse event related to aspiration. Prior history of pyloroplasty was found in 9 (47%) patients. Eight (89%) patients had pyloroplasty performed at time of esophagectomy and 1 (11%) patient had pre-existing history of gastroparesis at time of surgical pyloroplasty.
There was significant improvement in GCSI for all patients as a result of POP (mean pre 2.87±1.31 vs post 1.47±1.0, p<0.01) as well as sub-scores of nausea/vomiting (2.81±1.57 vs 0.91±0.94, p<0.01), postprandial fullness (3.53 ±1.32 vs 1.86±1.19, p<0.01), and bloating (2.36±1.46 vs 1.18±1.05, p<0.05).
Patients without prior history of pyloroplasty were found to account for the difference in improved overall GCSI (mean 3.38±0.96 vs post 1.22±0.85, p<0.01) as well as subscores of nausea/vomiting (3.17±1.3 vs 0.74±0.58, p<0.01), postprandial fullness (4.2±0.58 vs 1.61±1.19, p<0.01), and bloating (2.8±1.45 vs 1.3±1.18, p<0.05).
In patients with prior history of pyloroplasty prior to POP, there was no significant improvement in GES results or GCSI mean total or subscores pre and post-POP.
Conclusions:
Overall, patients with PSG demonstrated symptomatic improvement after POP. Prior history of pyloroplasty in patients with PSG may be a negative predictor for subsequent clinical improvement after POP for PSG. Further studies are needed to examine whether pyloric directed interventions should be deferred to endoscopic therapy after foregut surgery.
Table 1: Clinical and Procedural Data for Patients Undergoing POP for Post-Surgical Gastroparesis
Table 2: Response to POP in Patients with Post-surgical Gastroparesis with or without Prior History of Pyloroplasty
Back to 2020 Abstracts