World Congress at ACG2017

Presidential Plenary Session 1 (Free Paper/Abstract Presentations)

3 - Functional Obstructive Gastroparesis: Effect of Laparoscopic Pyloroplasty on Symptoms, Gastric Emptying, and Gastric Myoelectrical Activity After Successful Endoscopic Pyloric Therapies

Monday, October 16
8:24 AM - 8:36 AM
Location: Valencia Ballroom (Level 4)



Category: Stomach       

Jennifer Wellington, DO, Kenneth Koch, MD, Paula Stuart, PA-C
Wake Forest University School of Medicine, Winston-Salem, NC
Introduction: Gastroparesis (GP) with normal 3 cycle per minute (cpm) gastric myoelectrical activity (GMA) represents a GP subtype, functional obstructive GP, that responds to injection of Botulinum toxin A and balloon dilation of the pylorus. Aims: To determine the effect of pyloroplasty on symptoms, weight, gastric emptying, and GMA in patients with GP and normal 3 cpm GMA.

Methods: Ten patients (average age 36 years with GP and normal 3 cpm GMA) who had at least two successful endoscopic pyloric therapies and then underwent pyloroplasty were identified. Electrogastrography was performed using standard methods to determine GMA. Gastric emptying was measured with 4hr scintigraphy. Finney (n=4), Jaboulay (n=1) and Heineke-Mikulicz (n=5) pyloroplasties were performed.

Results: Six months after pyloroplasty, nine patients (90%) reported improved symptoms with an average weight increase of 6.4 lbs, range of -7 lbs to +20 lbs (p=0.04)Nausea, vomiting, abdominal pain and fullness were the major symptoms reported to be improved. Percentage of meal retained at 4 hrs improved from 47% before pyloroplasty to 16% after pyloroplasty (p 3 cpm GMA activity decreased significantly after pyloroplasty in the percentage distribution of power and percentage of time during baseline, 20 and 30 minute measurements after the WLT. Percentage distribution of power in the 3cpm range at baseline averaged 31% before and 19% after pyloroplasty (p < 0.01), at 20 minutes was 37% before and 25% after (p < 0.04) and at 30 minutes was 34% before and 23% after pyloroplasty (p < 0.01). The percentage of time the GMA was in the normal 3 cpm rhythm at baseline averaged 53% before and 17% after pyloroplasty (p < 0.01),at 20 minutes was 55% before and 16% after (p < 0.03) and at 30 minutes 57% before and 27% after pyloroplasty (p < 0.01).

Discussion: 1. After multiple successful endoscopic pyloric treatments, pyloroplasty in GP patients with 3 cpm GMA improved symptoms, gastric emptying and decreased 3 cpm GMA, consistent with relief of functional gastric outlet obstruction. 2. Pyloric neuromuscular dysfunction is a key factor in delayed emptying in patients with GP and normal 3 cpm GMA and represents a GP subtype—functional obstructive gastroparesis.

Supported by Industry Grant: No


Citation: . FUNCTIONAL OBSTRUCTIVE GASTROPARESIS: EFFECT OF LAPAROSCOPIC PYLOROPLASTY ON SYMPTOMS, GASTRIC EMPTYING, AND GASTRIC MYOELECTRICAL ACTIVITY AFTER SUCCESSFUL ENDOSCOPIC PYLORIC THERAPIES. Program No. 3. World Congress of Gastroenterology at ACG2017 Meeting Abstracts. Orlando, FL: American College of Gastroenterology.

Jennifer Wellington

Dr.
Wake Forest University School of Medicine
Winston-Salem, North Carolina

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3 - Functional Obstructive Gastroparesis: Effect of Laparoscopic Pyloroplasty on Symptoms, Gastric Emptying, and Gastric Myoelectrical Activity After Successful Endoscopic Pyloric Therapies



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