Advertisement

Laparoscopic Pyloroplasty for Gastroparesis

April 15, 2014

Laparoscopic Pyloroplasty for Gastroparesis

  1. Allan S. Brett, MD

In a case series, 41 of 50 patients reportedly improved after this procedure.

  1. Allan S. Brett, MD

Causes of gastroparesis include diabetes, medications, neurological disorders, and prior upper abdominal surgeries that might affect gastric emptying; many cases are idiopathic. Invasive approaches, including gastric pacing and surgical intervention, are options for treating severely symptomatic patients who don't respond to motility drugs and dietary measures. In this retrospective case series, surgeons at Emory University present 50 patients who underwent laparoscopic pyloroplasty for gastroparesis. In this procedure, the surgeon widens the pyloric outlet by making a longitudinal incision through the pylorus and closing the incision transversely.

Most patients (82%) reported improved symptoms at 1 month after surgery. Median half-life for gastric emptying (according to nuclear scans, done in 66% of patients) improved from 180 minutes to 60 minutes. Five patients (10%) who did not respond to initial surgery required “additional gastric drainage procedures.”

Comment

We chose to summarize this study for NEJM Journal Watch General Medicine to alert readers that this surgical procedure is being done for severe gastroparesis and not because these findings prove its efficacy. In this study, follow-up of symptoms was only 1 month, symptoms were not recorded in a standardized format, and the authors provide inadequate background information about the suspected causes of gastroparesis in these patients (only 10% of whom had diabetes). Obviously, prospective, controlled studies with robust endpoints are needed.

  • Disclosures for Allan S. Brett, MD at time of publication Nothing to disclose

Citation(s):

Your Comment

(will not be published)

Filtered HTML

  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Do you have any conflict of interest to disclose?
CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.
Image CAPTCHA
Enter the characters shown in the image.

Vertical Tabs

* Required

Reader comments are intended to encourage lively discussion of clinical topics with your peers in the medical community. We ask that you keep your remarks to a reasonable length, and we reserve the right to withhold publication of remarks that do not meet this standard.

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.

Advertisement
Advertisement
Advertisement