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Per-Oral Pyloromyotomy (POP) for Medically Refractory Post-Surgical Gastroparesis.

Publication ,  Journal Article
Strong, AT; Landreneau, JP; Cline, M; Kroh, MD; Rodriguez, JH; Ponsky, JL; El-Hayek, K
Published in: J Gastrointest Surg
June 2019

BACKGROUND: Post-surgical gastroparesis (psGP) is putatively related to vagal denervation from either therapeutic transection or inadvertent injury. Here, we present a series of patients undergoing endoscopic per-oral pyloromyotomy (POP) as a treatment for medically refractory psGP. METHODS: Patients identified from a prospectively maintained database of patients undergoing POP procedures at our institution from January 2016 to January 2018 were included. Surgical history, symptom scores, and gastric emptying studies before and 3 months after POP were additionally recorded. RESULTS: During the study period, 177 POP procedures were performed, of which 38 (21.5%) were for psGP. The study cohort was 84.2% female with a mean body mass index of 27.6 kg/m2 and mean age of 55.2 years. Common comorbidities included hypertension (34.2%), depression (31.6%), and gastroesophageal reflux disease (28.9%). Hiatal/paraesophageal hernia repair (39.5%) or fundoplication (36.8%) preceded psGP diagnosis most often. The mean operative time was 30 ± 20 min. There were no intraoperative complications. Mean postoperative length of stay was 1.2 days. There were two readmissions within 30 days, one for melena and one for dehydration. The mean improvement in total Gastroparesis Symptom Index Score was 1.29 (p = 0.0002). The mean 4-h gastric retention improved from a pre-POP mean of 46.4 to 17.9% post-POP. Normal gastric emptying was noted in 50% of subjects with available follow-up imaging. CONCLUSION: POP is a safe and effective endoscopic therapy for patients with psGP. POP should be considered a reasonable first-line option for patients with medically refractory psGP and may allow stomach preservation.

Published In

J Gastrointest Surg

DOI

EISSN

1873-4626

Publication Date

June 2019

Volume

23

Issue

6

Start / End Page

1095 / 1103

Location

Netherlands

Related Subject Headings

  • Treatment Outcome
  • Surgery
  • Retreatment
  • Pyloromyotomy
  • Postoperative Complications
  • Operative Time
  • Middle Aged
  • Male
  • Length of Stay
  • Humans
 

Citation

APA
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ICMJE
MLA
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Strong, A. T., Landreneau, J. P., Cline, M., Kroh, M. D., Rodriguez, J. H., Ponsky, J. L., & El-Hayek, K. (2019). Per-Oral Pyloromyotomy (POP) for Medically Refractory Post-Surgical Gastroparesis. J Gastrointest Surg, 23(6), 1095–1103. https://doi.org/10.1007/s11605-018-04088-7
Strong, Andrew T., Joshua P. Landreneau, Michael Cline, Matthew D. Kroh, John H. Rodriguez, Jeffrey L. Ponsky, and Kevin El-Hayek. “Per-Oral Pyloromyotomy (POP) for Medically Refractory Post-Surgical Gastroparesis.J Gastrointest Surg 23, no. 6 (June 2019): 1095–1103. https://doi.org/10.1007/s11605-018-04088-7.
Strong AT, Landreneau JP, Cline M, Kroh MD, Rodriguez JH, Ponsky JL, et al. Per-Oral Pyloromyotomy (POP) for Medically Refractory Post-Surgical Gastroparesis. J Gastrointest Surg. 2019 Jun;23(6):1095–103.
Strong, Andrew T., et al. “Per-Oral Pyloromyotomy (POP) for Medically Refractory Post-Surgical Gastroparesis.J Gastrointest Surg, vol. 23, no. 6, June 2019, pp. 1095–103. Pubmed, doi:10.1007/s11605-018-04088-7.
Strong AT, Landreneau JP, Cline M, Kroh MD, Rodriguez JH, Ponsky JL, El-Hayek K. Per-Oral Pyloromyotomy (POP) for Medically Refractory Post-Surgical Gastroparesis. J Gastrointest Surg. 2019 Jun;23(6):1095–1103.
Journal cover image

Published In

J Gastrointest Surg

DOI

EISSN

1873-4626

Publication Date

June 2019

Volume

23

Issue

6

Start / End Page

1095 / 1103

Location

Netherlands

Related Subject Headings

  • Treatment Outcome
  • Surgery
  • Retreatment
  • Pyloromyotomy
  • Postoperative Complications
  • Operative Time
  • Middle Aged
  • Male
  • Length of Stay
  • Humans