Tailored Approach to Gastroparesis Significantly Improves Symptoms

L E Arthur, MD¹, W S Richardson². ¹University of Queensland- Ochsner Clinical School, ²Ochsner Clinic Foundation

Introduction: Gastroparesis is difficult to treat and many patients do not get relief of symptoms with medical therapy alone. Several operative approaches have been described. This study shows the result of our selective surgical approach for patients with gastroparesis.

Methods and Procedures: This was a retrospective study of prospective data from our electronic medical record and data symptom sheet. All patients had preoperative gastric emptying study (GES) showing gastroparesis, esophagogastroduodenoscopy (EGD) and either CT or upper GI series with small bowel follow-through (UGISBF). All patients had pre and post-operative symptom sheets where 7 symptoms were scored for both severity and frequency on a scale of 0-5. The scores were analyzed by a professional statistician using paired sample t test.

Results: There were 58 patients with surgery for gastroparesis. 33 had gastric stimulator (GS), 7 pyloroplasty (P), 16 with both gastric stimulator and pyloroplasty (GSP), and 2 sleeve gastrectomy (SG). For patients in the GSP group the second procedure was performed if there was insignificant improvement with the first procedure. There was no mortality. The follow up period was 6-316 weeks (mean 66.107, SD 69.42). GS significantly improved frequency and severity for all symptoms except frequency of bloating. P significantly improved nausea and vomiting severity and frequency of nausea and early satiety. Symptom improvement for GSP was measured from after the first to after the second procedure. GSP significantly improved all but vomiting severity and frequency of early satiety, postprandial fullness and epigastric pain.

Conclusion: All procedures significantly improved symptoms, although numbers are small in the P group. GS shows more improvement than P and if P or GS does not adequately improve symptoms GSP is appropriate. In our practice gastrectomy was reserved as a last resort.