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Obstructive Gastroparesis: Patient Selection and Effect of Laparoscopic Pyloroplasty

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Functional obstructive gastroparesis is an understudied subtype of gastroparesis with normal 3 cycle per minute gastric myoelectrical activity that responds to botulinum toxin A injection and balloon dilation of the pylorus.

Aims

To determine the effect of pyloroplasty on symptoms, weight, gastric emptying, and gastric myoelectrical activity in patients with gastroparesis and normal 3 cycle per minute gastric myoelectrical activity.

Methods

Ten patients (average age 36 years with gastroparesis and normal 3 cycle per minute gastric myoelectrical activity) who had at least two successful endoscopic pyloric therapies and then underwent pyloroplasty were identified. Electrogastrography with water load satiety test was performed to determine gastric myoelectrical activity. Gastric emptying was measured with 4-h scintigraphy.

Key Results

Six months after pyloroplasty, nine of ten patients reported improved symptoms and weight increased an average of 6.4 lb (p = 0.04). The average percentage of meal retained at 4 h decreased from 47% before to 16% after pyloroplasty (p < 0.01) and normalized in six patients. After pyloroplasty, the percent distribution of gastric myoelectrical activity power in the 3 cycle per minute range decreased at each measured interval compared with pre-pyloroplasty (p < 0.01).

Conclusions

(1) Pyloroplasty in these patients with obstructive gastroparesis improved gastric emptying and decreased 3 cycle per minute gastric myoelectrical activity, consistent with relief of functional gastric outlet obstruction. (2) Pyloric neuromuscular dysfunction is a key factor in delayed emptying in patients with functional obstructive gastroparesis.

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Acknowledgments

The authors wish to acknowledge the excellent secretarial assistance of Stuart Pickett.

Funding

Jennifer Wellington is financially supported by the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases grant number T32 DK067872.

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Authors and Affiliations

  1. Section on Gastroenterology, Department of Surgical Services, Wake Forest Baptist Medical Center, Winston-Salem, NC, 27157, USA

    Jennifer Wellington, Carl Westcott & Kenneth L. Koch

  2. Section on Gastroenterology, University of Maryland Medical Center, Baltimore, MD, 21210, USA

    Jennifer Wellington

  3. Section on Gastroenterology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA

    Paula Stuart & Kenneth L. Koch

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  1. Jennifer Wellington
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  2. Paula Stuart
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Contributions

Jennifer Wellington: conception and design, generation, collection, assembly, analysis and interpretation of data, drafting and critical revision of the manuscript.

Paula Stuart: conception and design of the study, generation and collection of data.

Carl Westcott: conception and design of the study, generation and collection of data, drafting of the manuscript.

Kenneth L. Koch: conception, design, and supervision of the study, generation, collection, analysis and interpretation of data, drafting, critical revision and approval of the final version of the manuscript.

Corresponding author

Correspondence to Kenneth L. Koch.

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The Wake Forest Baptist Medical Center institutional review board approved the study.

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Scientific Meeting Presentation

Presidential Plenary Session presentation at The American College of Gastroenterology Annual Scientific Meeting, October 2017, Orlando, FL

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Wellington, J., Stuart, P., Westcott, C. et al. Obstructive Gastroparesis: Patient Selection and Effect of Laparoscopic Pyloroplasty. J Gastrointest Surg 24, 1778–1784 (2020). https://doi.org/10.1007/s11605-019-04240-x

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  • DOI: https://doi.org/10.1007/s11605-019-04240-x

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