Surgical Treatment of Gastroparesis

Summary

Gastroparesis is a condition in which the stomach does not empty properly. While it is initially managed with lifestyle modifications and medications, some patients eventually require surgical intervention. This study focuses on the technical considerations and surgical approaches for dealing with gastroparesis patients, which include endoscopic, minimally-invasive, and open surgical techniques.

Abstract

Gastroparesis and intestinal dysmotility are life-altering diagnoses with no cure. Lifestyle changes, pharmacological, and surgical interventions are combined in a multidisciplinary fashion to improve the quality of life in this patient population. Starting with lifestyle changes, adjustments are made to the types and amounts of food consumed, medical conditions are optimized, and the use of narcotic pain medications as well as smoking is discontinued. For many, these changes are not enough, and antiemetics and promotility agents are used to control symptoms. Finally, when these measures fail, patients turn to surgery, which can include surgical alterations to the stomach, implantation of a gastric stimulator, placement of drainage tubes, and possibly even the complete removal of different organs, including the stomach or gallbladder. In our clinic, patients not only see a surgeon but also a gastroenterologist, dietitian, and psychologist. We strongly believe in a multidisciplinary approach to this condition. The goal is to provide patients with hope and help them live fuller and happier lives.

The study primarily addresses technical considerations and the surgical approach for patients diagnosed with gastroparesis. It outlines the entire process, starting from preparations before the surgery, encompassing the preoperative work-up, and detailing the steps involved in the surgical procedure. One of the key diagnostic challenges faced in treating gastroparesis patients is determining the underlying cause of the condition, as this information is critical for selecting the appropriate surgical intervention. Once the patient's condition has been categorized based on the cause, the medical team engages in a discussion with the patient regarding potential treatment options, which may include endoscopic procedures, minimally invasive techniques, or open surgery.

Introduction

Normally, food moves through the stomach into the intestines via coordinated contractions of the stomach, which are controlled by interstitial cells of Cajal (ICC) located throughout the gastrointestinal tract. Gastroparesis is a syndrome characterized by delayed gastric emptying in the absence of mechanical obstruction and is associated with multiple symptoms, including nausea, vomiting, early satiety, abdominal bloating, and abdominal pain¹.

The most common causes of gastroparesis include diabetes, idiopathic factors, autoimmune conditions, and post-surgical situations where an injury to the vagus nerves r....

Protocol

This protocol has received approval and adheres to the guidelines of the Institutional Review Board of the University of South Florida. These guidelines affirm that respect for all forms of life is an inherent characteristic of biological and medical scientists conducting research. Written informed consent was obtained from all patients prior to the procedures. The study included patients aged over 18 years with chronic, intractable (drug-refractory) nausea and vomiting resulting from gastroparesis of diabetic or idiopat.......

Discussion

Gastroparesis is a chronic disease for which there is currently no cure. Therefore, the primary focus of treatment is the management of symptoms. In cases where lifestyle changes, dietary adjustments, and medications do not effectively control symptoms, surgical intervention should be considered. Surgical treatment, such as pyloric surgery and/or the placement of a gastric stimulator, can significantly improve nausea and vomiting symptoms. In fact, when these two interventions are combined, they often lead to a more subs.......

Materials

Name	Company	Catalog Number	Comments
2-0 Sutures (absorbable)
3-0 V-loc	Medtronic		For closure of pyloroplasty
Bite Block	Endure	NBBW1-10	Mouth piece for use in endoscopy
Carr-Locke Injection Needle	Steris		Injection needle for creation of wheal
Clinical programmer	N’Vision
Coagrasper Hemostatic Forceps	Olympus	FD-411UR	For control of bleeding
Endoscopic Knife	Olympus	KD-640L	Through the scope knife used for mucostomy
Enterra Gastric leads	Enterra	4351	Leads for device
Enterra Gastric stimulator	Enterra	37800	Implantable device
HybridKnife	Erbe	20150-260 and -261	Alternative endoscopic knife