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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.
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.
Dig Dis Sci
EndoFLIP and Pyloric Dilation for Gastroparesis Symptoms Refractory to Pyloromyotomy/Pyloroplasty
Asad Jehangir et al.
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