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.”


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.

Editor Disclosures at Time of Publication

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


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