Joshua P Landreneau, MD1, Andrew T Strong, MD1, Kevin M El-Hayek, MD1, Matthew D Kroh, MD2, Jeffrey L Ponsky, MD1, John H Rodriguez, MD1. 1Cleveland Clinic, 2Cleveland Clinic Abu Dhabi
Introduction: Gastroparesis is a debilitating functional disorder of the stomach characterized by delayed gastric emptying absent an obstructive etiology. Surgical or endoscopic disruption of the pylorus has been utilized to treat this disease, but there is little evidence comparing laparoscopic pyloroplasty (LP) with endoscopic per-oral pyloromyotomy (POP). Herein we describe our experience at our institution using a propensity matched cohort study to compare outcomes between these procedures.
Methods: All patients who underwent LP for the treatment of gastroparesis from October 2014 through September 2017 at our institution were retrospectively reviewed. Propensity scores were used to match these patients 1:1 to patients undergoing POP during this time period based on gender, age, and etiology of gastroparesis (idiopathic, diabetic, or post-surgical). Symptom scoring using the Gastroparesis Cardinal Symptom Index (GCSI), 4-hour solid-phase scintigraphic gastric emptying study, wireless motility capsule studies, and perioperative outcomes were compared between matched cohorts.
Results: Thirty patients underwent LP for gastroparesis during the study period. The cohort was 76.7% female with a mean age of 45.4 years and a median body mass index of 25.77 kg/m2. The etiology of gastroparesis was 63.3% idiopathic (n=19), 20.0% post-surgical (n=6), and 16.7% diabetic (n=5) in this cohort. There were no significant differences in gender, age at the time of intervention, and etiology of gastroparesis in the POP cohort following propensity matching. Patients who underwent LP had a longer average length of stay (4.6 vs. 1.4 days, p<0.001), operative time (123.3 vs. 33.9 minutes, p<0.001), and estimated blood loss (12.9 vs. 0.33 mL, p<0.001). There were more complications in the LP cohort (40.0% vs. 16.7%, p=0.02), which included superficial or organ-space surgical site infection (6.6% vs. 3.3%, p=0.28), unplanned ICU admission (10.0% vs. 0.0%, p=0.04), readmission within 30 days (16.7% vs. 3.3%, p=0.042), and re-operation (n=1 in both cohorts). There were no mortalities in the LP cohort. One patient died within 30 days after undergoing POP from a cardiac event deemed unrelated to the procedure. LP and POP resulted in similar improvements in GCSI (LP 1.19 vs. POP 1.73, p=0.275). Solid-phase scintigraphic gastric emptying studies were available in seven patients post LP and eight patients after POP, with normal gastric emptying at 4 hours in each case.
Conclusions: Endoscopic per-oral pyloromyotomy (POP) is a safe and effective intervention for the treatment of medical refractory gastroparesis. POP has less perioperative morbidity compared to laparoscopic pyloroplasty with comparative functional outcomes.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88201
Program Number: S046
Presentation Session: Foregut Session
Presentation Type: Podium
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