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Gastrointestinal Endoscopy

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Techniques and devices for the endoscopic treatment of gastroparesis (with video) - 21/08/20

Doi : 10.1016/j.gie.2020.03.3857 
Mansour A. Parsi, MD, MPH, FASGE 1, Pichamol Jirapinyo, MD, MPH 2, Barham K. Abu Dayyeh, MD, MPH, FASGE 3, Manoop S. Bhutani, MD, FASGE 4, Vinay Chandrasekhara, MD 3, Kumar Krishnan, MD 5, Nikhil A. Kumta, MD, MS 6, Joshua Melson, MD, MPH, FASGE 7, Rahul Pannala, MD, MPH, FASGE 8, Guru Trikudanathan, MBBS 9, Arvind J. Trindade, MD 10, Amrita Sethi, MD, FASGE 11, Rabindra R. Watson, MD 12, John T. Maple, DO, FASGE, previous Committee Chair (2016-2019) 13, David R. Lichtenstein, MD, FASGE 14

ASGE Technology Committee Chair

1 Section for Gastroenterology and Hepatology, Tulane University Health Sciences Center, New Orleans, Louisiana, USA 
2 Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA 
3 Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA 
4 Department of Gastroenterology Hepatology and Nutrition, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA 
5 Division of Gastroenterology, Department of Internal Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA 
6 Division of Gastroenterology, Mount Sinai Hospital, New York, New York, USA 
7 Division of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA 
8 Division of Digestive Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA 
9 Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA 
10 Department of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA 
11 Department of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, New Hyde Park, New York, USA 
12 New York-Presbyterian Medical Center/Columbia University Medical Center, New York, New York, USA 
13 Department of Gastroenterology, Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA 
14 Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA 

Abstract

Background and Aims

Gastroparesis is a symptomatic chronic disorder of the stomach characterized by delayed gastric emptying in the absence of mechanical obstruction. Several endoscopic treatment modalities have been described that aim to improve gastric emptying and/or symptoms associated with gastroparesis refractory to dietary and pharmacologic management.

Methods

In this report we review devices and techniques for endoscopic treatment of gastroparesis, the evidence regarding their efficacy and safety, and the financial considerations for their use.

Results

Endoscopic modalities for treatment of gastroparesis can be broadly categorized into pyloric, nonpyloric, and nutritional therapies. Pyloric therapies such as botulinum toxin injection, stent placement, pyloroplasty, and pyloromyotomy specifically focus on pylorospasm as a therapeutic target. These interventions aim to reduce the pressure gradient across the pyloric sphincter, with a resultant improvement in gastric emptying. Nonpyloric therapies, such as venting gastrostomy and gastric electrical stimulation, are intended to improve symptoms. Nutritional therapies, such as feeding tube placement, aim to provide nutritional support.

Conclusions

Several endoscopic interventions have shown utility in improving the quality of life and symptoms of select patients with refractory gastroparesis. Methods to identify which patients are best suited for a specific treatment are not well established. Endoscopic pyloromyotomy is a relatively recent development that may prove to be the preferred pyloric-directed intervention, although additional and longer-term outcomes are needed.

Le texte complet de cet article est disponible en PDF.

Abbreviations : BTA, DPEJ, GES, POEM, POP, RCT


Plan


 DISCLOSURE: The following authors disclosed financial relationships: P. Jirapinyo: Consultant for GI Dynamics and Endogastric Solutions; research support from GI Dynamics, Apollo Endosurgery, and Fractyl. B. Abu Dayyeh: Consultant for Metamodix, BFKW, DyaMx, and Boston Scientific; research support from Apollo Endosurgery, USGI, Spatz Medical, GI Dynamics, Cairn Diagnostics, Aspire Bariatrics, and Medtronic; speaker for Johnson and Johnson, Endogastric Solutions, and Olympus. M. Bhutani: Research support from Silenseed Inc, Galera Inc, Oncosil Inc, and Augmenix Inc; food, beverage, or travel compensation from Boston Scientific, Augmentix, and Conmed Corporation. V. Chandrasekhara: Advisory board for Interpace Diagnostics; shareholder in Nevakar, Inc. K. Krishnan: Consultant for Olympus Medical. N. Kumta: Consultant for Boston Scientific, Olympus Corporation of the Americas, Gyrus ACMI, Inc, and Apollo Endosurgery US Inc. D. Lichtenstein: Consultant for Allergan Inc, Augmenix, Gyrus ACMI, Inc, and Olympus Corporation of the Americas; speaker for Aries Pharmaceutical, Gyrus ACMI, Inc, and Olympus Corporation of the Americas; tuition compensation from Erbe USA Inc. J. Melson: Research support from Boston Scientific; stock options in Virgo Imaging. R. Pannala: Consultant for HCL Technologies; travel compensation from Boston Scientific; stockholder in AbbVie. G. Trikudanathan: Speaker and honorarium from Boston Scientific; advisory board for Abbvie. A. Trindade: Consultant for Olympus Corporation of the Americas and Pentax of America, Inc; food and beverage compensation from Boston Scientific; research support from NinePoint Medical, Inc. A. Sethi: Consultant for Olympus America, Boston Scientific, and Fujifilm. R. Watson: Consultant for Apollo Endosurgery, Boston Scientific, Medtronic, and Neptune Medical Inc; speaker for Apollo Endosurgery and Boston Scientific.


© 2020  American Society for Gastrointestinal Endoscopy. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 92 - N° 3

P. 483-491 - septembre 2020 Retour au numéro
Article précédent Article précédent
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