Gastric Electrical Stimulation and Pyloric Surgery Effectively Improve Gastroparesis Symptoms

Researchers from the University of Wisconsin observed that patients with gastroparesis appeared to benefit from either gastric electrical stimulation (GES) or pyloric surgery, according to findings published in Surgical Endoscopy. A combination of GES and pyloric procedures (PP) was not found to confer an advantage over either intervention alone.

Patients (N=82) who underwent benign foregut surgery (GES, pyloroplasty, or pyloromyotomy) at the University of Wisconsin-Madison between 2011 and 2019 were prospectively included in the Research Electronic Data Capture database. Patients were contacted by telephone for 2-week, 6-week, and 12-month follow-ups and assessed by the gastroesophageal reflux disease health-related quality of life (GERD-HRQL) and gastroparesis cardinal symptom index (GCSI).

The median patient age was 44 years (range, 18-84), 80% were women, and the median body mass index was 26.7 kg/m² (interquartile range [IQR], 23.0-32.5). Regarding gastroparesis type, 32% had diabetic gastroparesis, 43% had idiopathic gastroparesis, and 25% had postsurgical gastroparesis.

The median emptying half time was 178 minutes (IQR, 151-331). The baseline GERD-HRQL score was 12 (IQR, 4-21); the median GCSI score, 3.7 (IQR, 2.9-4.5). There were 3 different treatment groups: patients who had a PP (n=51), a GES placed (n=18), or GES plus PP (n=13). These groups differed significantly for age (P =.014), sex (P =.021), and gastroparesis type (P <.001).

At 6-weeks post procedure, GCSI scores improved among those in the PP group from 3.6 to 1.8, constituting the “largest numeric improvement” of the 3 groups, according to the study authors. The GES group, however, had the largest improvement in GCSI score at 1 year (3.9 to 2.0). At 1 year, all groups’ GCSI scores had decreased to a range considered clinically successful.

Notably, the nausea and vomiting GCSI subscore showed the greatest improvement among all participants post-surgery. Across the groups, the median preoperative score was 3.3 (IQR, 2-4.7). By the 6-week mark, this subscore was 2.7, 1.3, and 1.0 in the GES, PP, and GES plus PP groups, respectively.

At 1 year, median nausea/vomiting subscores of 0 to 1.5 were observed across all groups. Patients with postsurgical gastroparesis who underwent PP had the largest improvement in GCSI nausea/vomiting and fullness subscores, but these values did not reach statistical significance.

Overall, surgery was deemed a clinical success in most patients (71.9%) based on symptom scores and no need for further surgical intervention for gastroparesis. Patients in whom surgery failed did not differ significantly for demographic parameters, but were more likely to have higher preoperative GCSI score (4.5 vs 3.6 ; P =.02) and elevated bloating subscore (5 vs 3.5; P =.017) compared with patients in whom surgery was efficacious.

Clinical success of an individual gastroparesis operation was observed among 61.1% of the GES group, 72.5% of the PP cohort, and 84.6% of the GES plus PP group. “The success rate was not significantly different based on operation performed,” the study authors stated. After the procedure, 10 patients needed an additional surgery at a median interval of 8 months. After their additional surgery, 3 of the patients achieved clinical success.

This study was limited by its single-center nature and according lack of randomization and small sample size. The high degree of difference between the patient groups was another limiting factor.

The study authors stated that “gastric electrical stimulation, pyloric surgery, and a combination of these 2 modalities are all effective long-term in improving symptoms related to gastroparesis.” The choice of surgical approach should be guided by the patient’s symptoms and the goals of surgery, they concluded.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of authors’ disclosures.

Reference

Marowski S, Xu Y, Greenberg JA, Funk LM, Lidor AO, Shada AL. Both gastric electrical stimulation and pyloric surgery offer long‑term symptom improvement in patients with gastroparesis. Surg Endosc. Published online October 6, 2020.  doi: 10.1007/s00464-020-07960-3