GASTRIC PER ORAL PYLOROMYOTOMY AND ENDOFLIP COMBINED APPROACH FOR MANAGEMENT OF GASTROPARESIS
Clayton O. Rooks*, Ashley E. Williams, Jacob R. Moremen
Surgery, The University of Mississippi Medical Center, Jackson, MS
Preoperative EndoFLIP was done to characterize the pylorus. The distensibility index (DI), minimum diameter (Dmin), and cross sectional area (CSA) were assessed and recorded at 40 and 50 mL fill volumes. Orise gel was then injected into submucosal space. Mucosal incision was made and submucosal plane was developed with monopolar cautery until duodenal fibers were seen over pyloric ridge. A retrograde circular myotomy was made with cautery. The mucosotomy was closed with running suture. Postoperatively, EndoFLIP was performed at the same site and volumes. The final DI, Dmin, and CSA at 50 mL increased from 6.7 to 7.5 mm2/mmHg (12%), 18.7 to 19.6 mm (5%), and 276 to 303 mm2 (10%) respectively
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