Pyloromyotomy/pyloroplasty is a common gastric emptying procedure performed for the treatment of chronic refractory symptoms in gastroparesis patients, but symptoms still persist in some patients. Pyloric EndoFLIP followed by pyrolic dilation provides symptomatic improvement in gastroparesis refractory to pyloromyotomy/pyloroplasty, as per findings of the latest study. 

The present study was conducted to determine endoscopic functional luminal imaging probe (EndoFLIP) characteristics of these patients before dilation and the efficacy of Pyloric through-the-scope (TTS) balloon dilation in improving symptoms in gastroparesis patients with suboptimal response to pyloromyotomy/pyloroplasty.

Patients developing severe gastroparesis from 2/2019 to 3/2020 were enrolled. Pyrolic characteristics were assessed in all patients using EndoFLIP and thereafter, pyloric TTS dilation was performed. Gastroparesis Cardinal Symptom Index (GCSI) questionnaire was completed by patients before the procedure and on follow up whereas Clinical Patient Grading Assessment Scale (CPGAS) was completed only on follow-ups.

Among study participants, 13 patients (10 females+ 3 males) with severe gastroparesis symptoms after pyloromyotomy/pyloroplasty underwent pyloric TTS dilation. An improvement in mean GCSI scores and CPGAS scores was observed at a 1-month follow-up (mean CPGAS score 1.6 ± 0.5 and mean GCSI total score of 3.0 ± 0.4). Five patients reported moderate to better improvement in symptoms.

There were no significant differences observed in mean pre-TTS dialation pyrolic diameter but a reduction in Pre-dialation pyloric EndoFLIP distensibility was observed at 30 ml, 40 ml, and 50 ml in patients with the symptomatic improvement compared to patients with little/no improvement as described in the following table: 

The results indicated improvement in refractory symptoms in about a third of patients after pyloromyotomy/pyloroplasty. Lower pre-dialation distensibility on EndoFLIP in patients with symptom improvement suggests incomplete myotomy, pyloric muscle regeneration, or pyloric stricture. Pyloric EndoFLIP followed by TTS dilation is effective for the treatment of gastroparesis symptoms refractory to pyloromyotomy/pyloroplasty.