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Both gastric electrical stimulation and pyloric surgery offer long-term symptom improvement in patients with gastroparesis.

Publication ,  Journal Article
Marowski, S; Xu, Y; Greenberg, JA; Funk, LM; Lidor, AO; Shada, AL
Published in: Surg Endosc
August 2021

BACKGROUND: Gastroparesis (GP) is hallmarked by nausea, vomiting, and early satiety. While dietary and medical therapy are the mainstay of treatment, surgery has been used to palliate symptoms. Two established first-line surgical options are gastric electrostimulation (GES) and pyloric procedures (PP) including pyloroplasty or pyloromyotomy. We sought to compare these modalities' improvement in Gastroparesis cardinal symptom index (GCSI) subscores and potential predictors of therapy failure. METHODS: All patients undergoing surgery at a single institution were prospectively identified and separated by surgery: GES, PP, or combined GESPP. GCSI was collected preoperatively, at 6 weeks and 1 year. Postoperative GCSI score over 2.5 or receipt of another gastroparesis operation were considered treatment failures. Groups were compared using Pearson's chi-squared and Kruskal-Wallis one-way ANOVA. RESULTS: Eighty-two patients were included: 18 GES, 51 PP, and 13 GESPP. Mean age was 44, BMI was 26.7, and 80% were female. Preoperative GCSI was 3.7. The PP group was older with more postsurgical gastroparesis. More patients with diabetes underwent GESPP. Preoperative symptom scores and gastric emptying were similar among all groups. All surgical therapies resulted in a significantly improved GCSI and nausea/vomiting subscore at 6 weeks and 1 year. Bloating improved initially, but relapsed in the GES and GESPP group. Satiety improved initially, but relapsed in the PP group. Fifty-nine (72%) had surgical success. Ten underwent additional surgery (7 crossed into the GESPP group, 3 underwent gastric resection). Treatment failures had higher preoperative GCSI, bloating, and satiety scores. Treatment failures and successes had similar preoperative gastric emptying. CONCLUSIONS: Both gastric electrical stimulation and pyloric surgery are successful gastroparesis treatments, with durable improvement in nausea and vomiting. Choice of operation should be guided by patient characteristics and discussion of surgical risks and benefits. Combination GESPP does not appear to confer an advantage over GES or PP alone.

Duke Scholars

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Published In

Surg Endosc

DOI

EISSN

1432-2218

Publication Date

August 2021

Volume

35

Issue

8

Start / End Page

4794 / 4804

Location

Germany

Related Subject Headings

  • Treatment Outcome
  • Surgery
  • Pylorus
  • Pyloromyotomy
  • Humans
  • Gastroparesis
  • Gastric Emptying
  • Female
  • Electric Stimulation Therapy
  • Electric Stimulation
 

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Marowski, S., Xu, Y., Greenberg, J. A., Funk, L. M., Lidor, A. O., & Shada, A. L. (2021). Both gastric electrical stimulation and pyloric surgery offer long-term symptom improvement in patients with gastroparesis. Surg Endosc, 35(8), 4794–4804. https://doi.org/10.1007/s00464-020-07960-3
Marowski, Sarah, Yiwei Xu, Jake A. Greenberg, Luke M. Funk, Anne O. Lidor, and Amber L. Shada. “Both gastric electrical stimulation and pyloric surgery offer long-term symptom improvement in patients with gastroparesis.Surg Endosc 35, no. 8 (August 2021): 4794–4804. https://doi.org/10.1007/s00464-020-07960-3.
Marowski S, Xu Y, Greenberg JA, Funk LM, Lidor AO, Shada AL. Both gastric electrical stimulation and pyloric surgery offer long-term symptom improvement in patients with gastroparesis. Surg Endosc. 2021 Aug;35(8):4794–804.
Marowski, Sarah, et al. “Both gastric electrical stimulation and pyloric surgery offer long-term symptom improvement in patients with gastroparesis.Surg Endosc, vol. 35, no. 8, Aug. 2021, pp. 4794–804. Pubmed, doi:10.1007/s00464-020-07960-3.
Marowski S, Xu Y, Greenberg JA, Funk LM, Lidor AO, Shada AL. Both gastric electrical stimulation and pyloric surgery offer long-term symptom improvement in patients with gastroparesis. Surg Endosc. 2021 Aug;35(8):4794–4804.
Journal cover image

Published In

Surg Endosc

DOI

EISSN

1432-2218

Publication Date

August 2021

Volume

35

Issue

8

Start / End Page

4794 / 4804

Location

Germany

Related Subject Headings

  • Treatment Outcome
  • Surgery
  • Pylorus
  • Pyloromyotomy
  • Humans
  • Gastroparesis
  • Gastric Emptying
  • Female
  • Electric Stimulation Therapy
  • Electric Stimulation