Peroral Pyloromyotomy (POP) for Medically Refractory Gastroparesis: Short Term Results from a High Volume Center
John Rodriguez*, Andrew T. Strong*, Ivy N. Haskins*, Joshua P. Landreneau*, Matthew T. Allemang*, Kevin El-Hayek*, James Villamere*, Michael S. Cline*, Matthew Kroh*, Jeffrey L. Ponsky
Cleveland Clinic, Cleveland, OH
OBJECTIVE(S): Pyloric division may relieve symptoms and improve gastric emptying for patients with gastroparesis. Peroral pyloromyotomy (POP) is an innovative endoscopic procedure to divide the pylorus within a submucosal tunnel. Here we evaluate subjective and objective outcomes 12-weeks after POP at a high volume center.
METHODS: All patients with procedure dates between January 2016 and August 2017 and 12-week follow-up available were included. Patients were evaluated using the Gastroparesis Cardinal Symptom Index (GCSI), and 4-hour scintigraphic gastric emptying studies (GES).
RESULTS: There were 95 patients who underwent POP procedures during the study period (84.2% female, mean age of 44.9 years). Gastroparesis etiologies were divided among idiopathic (54.7%), diabetes (22.1%), post-surgical (18.9%) and other in 4.2%. There were 68.2% of the patients who had previous endoscopic or surgical interventions for gastroparesis. Most POP procedures were performed in the operating room (96.7%), and were completed in an average of 34 minutes. Ten patients incurred complications (10.5%), which included 1 diagnostic laparoscopy, and 4 repeat endoscopy procedures. Overall GCSI improved from a preoperative mean of 3.82±0.86 to 2.54±1.27; p<0.0001). The improvement in each GCSI sub-score was also highly statistically significant. Among the patients with postoperative GES available, 79.4% had objectively better 4-hour emptying with a mean improvement of 17.6% (p=0.0015), and which included 68.6% with normal 4-hour emptying.
CONCLUSIONS: For patients with medically refractory gastroparesis, POP results in both subjective and objective improvement in the majority of patients. POP should be included along the treatment algorithm for patients with this progressive disease.
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