EndoFLIP and Pyloric Dilation for Gastroparesis Symptoms Refractory to Pyloromyotomy/Pyloroplasty

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BACKGROUND: Gastroparesis patients may undergo pyloromyotomy/pyloroplasty for chronic refractory symptoms. However, some patients have persistent symptoms. It is unknown if balloon dilation may improve their symptoms.

AIMS: We aimed to (1) assess if pyloric through-the-scope (TTS) balloon dilation results in symptom improvement in gastroparesis patients with suboptimal response to pyloromyotomy/pyloroplasty and (2) determine endoscopic functional luminal imaging probe (EndoFLIP) characteristics of these patients before dilation.

METHODS: Patients with severe gastroparesis refractory to pyloromyotomy/pyloroplasty seen from 2/2019 to 3/2020 underwent pyloric TTS dilation after assessing the pyloric characteristics using EndoFLIP. Patients completed Gastroparesis Cardinal Symptom Index (GCSI) pre-procedurally, and GCSI and Clinical Patient Grading Assessment Scale (CPGAS) on follow-ups.

RESULTS: Thirteen (ten females) patients (mean age 45.2 ± 5.1 years) with severe gastroparesis symptoms (mean GCSI total score 3.4 ± 0.3) after pyloromyotomy/pyloroplasty underwent pyloric TTS dilation. Overall, there was improvement in symptoms at 1-month follow-up (mean GCSI total score 3.0 ± 0.4, mean CPGAS score 1.6 ± 0.5, p < 0.05 for both), with five (38%) patients reporting symptoms somewhat/moderately better. The patients with symptom improvement had lower pre-dilation pyloric EndoFLIP distensibility at 30 ml, 40 ml, and 50 ml than patients with little/no improvement (all p < 0.05).

CONCLUSIONS: In gastroparesis patients with refractory symptoms after pyloromyotomy/pyloroplasty, pyloric TTS dilation improved symptoms in about a third of the patients. Patients with symptom improvement had lower pre-dilation pyloric distensibility on EndoFLIP suggesting incomplete myotomy, pyloric muscle regeneration, or pyloric stricture. Pyloric EndoFLIP followed by TTS dilation seems to be a promising treatment for some patients with gastroparesis symptoms refractory to pyloromyotomy/pyloroplasty.

Errataetall:

CommentIn: Dig Dis Sci. 2021 Aug;66(8):2475-2477. - PMID 32945984

Medienart:

E-Artikel

Erscheinungsjahr:

2021

Erschienen:

2021

Enthalten in:

Zur Gesamtaufnahme - volume:66

Enthalten in:

Digestive diseases and sciences - 66(2021), 8 vom: 04. Aug., Seite 2682-2690

Sprache:

Englisch

Beteiligte Personen:

Jehangir, Asad [VerfasserIn]
Malik, Zubair [VerfasserIn]
Petrov, Roman V [VerfasserIn]
Parkman, Henry P [VerfasserIn]

Links:

Volltext

Themen:

Dilation
EndoFLIP
Journal Article
Pyloromyotomy
Pyloroplasty
Pylorus
TTS

Anmerkungen:

Date Completed 22.09.2021

Date Revised 22.09.2021

published: Print-Electronic

CommentIn: Dig Dis Sci. 2021 Aug;66(8):2475-2477. - PMID 32945984

Citation Status MEDLINE

doi:

10.1007/s10620-020-06510-0

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

NLM313248990