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Per-Oral Pyloromyotomy (POP) for Medically Refractory Post-Surgical Gastroparesis
Andrew T Strong1,2, Joshua P Landreneau1,2, Michael Cline2,3
1Department of General Surgery, Cleveland Clinic, Desk A-100, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
Summary
Endoscopic per-oral pyloromyotomy (POP) effectively treats post-surgical gastroparesis (psGP) by improving gastric emptying and symptoms. This minimally invasive procedure offers a safe and viable option for patients with refractory psGP.
Area of Science:
- Gastroenterology
- Minimally Invasive Surgery
- Endoscopic Procedures
Background:
- Post-surgical gastroparesis (psGP) is often linked to vagal nerve damage during abdominal surgeries.
- Medical treatments for psGP can be ineffective, necessitating alternative therapeutic approaches.
Purpose of the Study:
- To evaluate the safety and efficacy of endoscopic per-oral pyloromyotomy (POP) for treating medically refractory psGP.
- To assess the impact of POP on symptom scores and gastric emptying in psGP patients.
Main Methods:
- A retrospective analysis of patients undergoing POP for psGP between January 2016 and January 2018.
- Collected data included surgical history, symptom scores (Gastroparesis Symptom Index), and gastric emptying studies pre- and post-POP.
Main Results:
- Out of 177 POP procedures, 38 were for psGP. The cohort was predominantly female (84.2%) with a mean age of 55.2 years.
- POP demonstrated significant improvement in Gastroparesis Symptom Index scores (p=0.0002) and reduced 4-hour gastric retention from 46.4% to 17.9%.
- 50% of patients achieved normal gastric emptying post-procedure, with a low complication rate and short hospital stay.
Conclusions:
- Endoscopic per-oral pyloromyotomy (POP) is a safe and effective treatment for post-surgical gastroparesis (psGP).
- POP represents a valuable first-line therapeutic option for patients with medically refractory psGP, potentially preserving stomach function.
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