Refractory gastroparesis can be successfully managed with endoscopic transpyloric stent placement and fixation (with video) - 01/06/16
Abstract |
Background and Aims |
Medical treatment options for gastroparesis are limited. Data from studies of botulinum toxin and surgical pyloroplasty suggest that disruption of the pylorus can result in symptomatic improvement in some patients with refractory gastroparetic symptoms. The aim of this study was to determine the clinical response to transpyloric stent (TPS) placement in patients with gastroparetic symptoms refractory to standard therapy.
Methods |
Patients with gastroparesis refractory to medical treatment were referred for TPS placement for salvage therapy. Self-reported symptom improvement, stent migration rate, and pre– and post–stent gastric-emptying study results were collected.
Results |
A total of 30 patients with refractory gastroparesis underwent 48 TPS procedures. Of these, 25 of 48 (52.1%) were performed in patients admitted to the hospital with intractable gastroparetic symptoms. Successful stent placement in the desired location across the pylorus (technical success) was achieved during 47 procedures (98%). Most (n = 24) stents were anchored to the gastric wall by using endoscopic suturing with a mean number of sutures of 2 (range 1-3) per procedure. Clinical response was observed in 75% of patients, and all inpatients were successfully discharged. Clinical success in patients with the predominant symptoms of nausea and vomiting was higher than in those patients with a predominant symptom of pain (79% vs 21%, P = .12). A repeat gastric-emptying study was performed in 16 patients, and the mean 4-hour gastric emptying normalized in 6 patients and significantly improved in 5 patients. Stent migration was least common (48%) when stents were sutured.
Conclusion |
TPS placement is a feasible novel endoscopic treatment modality for gastroparesis and improves both symptoms and gastric emptying in patients who are refractory to medical treatment, especially those with nausea and vomiting. TPS placement may be considered as salvage therapy for inpatients with intractable symptoms or potentially as a method to select patients who may respond to more permanent therapies directed at the pylorus.
Il testo completo di questo articolo è disponibile in PDF.Abbreviations : ES, OTSC, TPN, TPS
Mappa
| DISCLOSURE: Dr Khashab is a consultant for Boston Scientific, Olympus, and Xlumena. Dr Kalloo is a founding member of, equity holder in, and consultant for Apollo Endosurgery. All other authors disclosed no financial relationships relevant to this publication. |
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| If you would like to chat with an author of this article, you may contact Dr Khashab at mkhasha1@jhmi.edu. |
Vol 82 - N° 6
P. 1106-1109 - dicembre 2015 Ritorno al numero
Articolo precedente
- Continuing Medical Education Exam: December 2015
- James Buxbaum, Karthik Ravi, William Ross, Brian Weston, Prasad G. Iyer, David Schwartz, Michael B. Wallace
- EUS-guided gallbladder drainage with a lumen-apposing metal stent (with video)
- Shayan Irani, Todd H. Baron, Ian S. Grimm, Mouen A. Khashab
Benvenuto su EM|consulte, il riferimento dei professionisti della salute.
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