Gastroparesis surgery: Difference between revisions

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__NOTOC__
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{{Gastroparesis}}
{{Gastroparesis}}
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==Overview==
==Overview==
Surgical treatment is rarely indicated for the treatment of gastroparesis, however it can be useful in patients with persistent symptoms despite medical management.
Surgical treatment is rarely indicated for the treatment of gastroparesis, however it can be useful in patients with persistent [[symptoms]] despite medical management.


==Surgery==
==Surgery==
Surgical treatment is rarely indicated for the treatment of gastroparesis, however it can be useful in patients with persistent symptoms despite medical management.
Surgical treatment is rarely indicated for the treatment of gastroparesis, however it can be useful in patients with persistent [[symptoms]] despite medical management.
===Surgical techniques===
===Surgical techniques===
Following surgical options are available:
Following surgical options are available for the surgical management of gastroparesis:<ref name="pmid3921005">{{cite journal| author=Pitt HA, Mann LL, Berquist WE, Ament ME, Fonkalsrud EW, DenBesten L| title=Chronic intestinal pseudo-obstruction. Management with total parenteral nutrition and a venting enterostomy. | journal=Arch Surg | year= 1985 | volume= 120 | issue= 5 | pages= 614-8 | pmid=3921005 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3921005  }} </ref><ref name="pmid8540505">{{cite journal| author=Murr MM, Sarr MG, Camilleri M| title=The surgeon's role in the treatment of chronic intestinal pseudoobstruction. | journal=Am J Gastroenterol | year= 1995 | volume= 90 | issue= 12 | pages= 2147-51 | pmid=8540505 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8540505  }} </ref><ref name="pmid12560910">{{cite journal| author=Shibata C, Naito H, Funayama Y, Fukushima K, Hashimoto A, Kitayama T et al.| title=Surgical treatment of chronic intestinal pseudo-obstruction: report of three cases. | journal=Surg Today | year= 2003 | volume= 33 | issue= 1 | pages= 58-61 | pmid=12560910 | doi=10.1007/s005950300011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12560910  }} </ref><ref name="pmid16291165">{{cite journal| author=Kim HY, Kim JH, Jung SE, Lee SC, Park KW, Kim WK| title=Surgical treatment and prognosis of chronic intestinal pseudo-obstruction in children. | journal=J Pediatr Surg | year= 2005 | volume= 40 | issue= 11 | pages= 1753-9 | pmid=16291165 | doi=10.1016/j.jpedsurg.2005.07.046 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16291165  }} </ref><ref name="pmid14572555">{{cite journal| author=Jones MP, Maganti K| title=A systematic review of surgical therapy for gastroparesis. | journal=Am J Gastroenterol | year= 2003 | volume= 98 | issue= 10 | pages= 2122-9 | pmid=14572555 | doi=10.1111/j.1572-0241.2003.07721.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14572555  }} </ref><ref name="pmid2910126">{{cite journal| author=Karlstrom L, Kelly KA| title=Roux-Y gastrectomy for chronic gastric atony. | journal=Am J Surg | year= 1989 | volume= 157 | issue= 1 | pages= 44-9 | pmid=2910126 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2910126  }} </ref><ref name="pmid23147521">{{cite journal| author=Camilleri M, Parkman HP, Shafi MA, Abell TL, Gerson L, American College of Gastroenterology| title=Clinical guideline: management of gastroparesis. | journal=Am J Gastroenterol | year= 2013 | volume= 108 | issue= 1 | pages= 18-37; quiz 38 | pmid=23147521 | doi=10.1038/ajg.2012.373 | pmc=3722580 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23147521  }} </ref><ref name="pmid8855743">{{cite journal| author=Fontana RJ, Barnett JL| title=Jejunostomy tube placement in refractory diabetic gastroparesis: a retrospective review. | journal=Am J Gastroenterol | year= 1996 | volume= 91 | issue= 10 | pages= 2174-8 | pmid=8855743 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8855743  }} </ref><ref name="pmid24914371">{{cite journal| author=Pang B, Zhou Q, Li JL, Zhao LH, Tong XL| title=Treatment of refractory diabetic gastroparesis: Western medicine and traditional Chinese medicine therapies. | journal=World J Gastroenterol | year= 2014 | volume= 20 | issue= 21 | pages= 6504-14 | pmid=24914371 | doi=10.3748/wjg.v20.i21.6504 | pmc=4047335 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24914371  }} </ref><ref name="pmid24836745">{{cite journal| author=Chaves DM, de Moura EG, Mestieri LH, Artifon EL, Sakai P| title=Endoscopic pyloromyotomy via a gastric submucosal tunnel dissection for the treatment of gastroparesis after surgical vagal lesion. | journal=Gastrointest Endosc | year= 2014 | volume= 80 | issue= 1 | pages= 164 | pmid=24836745 | doi=10.1016/j.gie.2014.03.045 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24836745  }} </ref><ref name="pmid26140897">{{cite journal| author=Mancini SA, Angelo JL, Peckler Z, Philp FH, Farah KF| title=Pyloroplasty for Refractory Gastroparesis. | journal=Am Surg | year= 2015 | volume= 81 | issue= 7 | pages= 738-46 | pmid=26140897 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26140897  }} </ref>
*Placement of an entrostomy tube
*Placement of an entrostomy tube such as [[gastrostomy]] or jejunostomy tube
*Surgical pyloroplasty
*Surgical [[pyloroplasty]]
*Subtotal gastrectomy  
*Subtotal [[gastrectomy]]
*[[Endoscopic]] [[pyloromyotomy]] (gastric per-oral [[endoscopic]] [[myotomy]])
*[[Laparoscopic surgery|Laparoscopic]] [[pyloroplasty]]
 
===Decompression and enterostomy tube placement===
A [[percutaneous]] [[endoscopic]] [[gastrostomy]] tube is used to decompress the [[upper gastrointestinal tract]].<ref name="pmid24120337">{{cite journal| author=Khashab MA, Stein E, Clarke JO, Saxena P, Kumbhari V, Chander Roland B et al.| title=Gastric peroral endoscopic myotomy for refractory gastroparesis: first human endoscopic pyloromyotomy (with video). | journal=Gastrointest Endosc | year= 2013 | volume= 78 | issue= 5 | pages= 764-8 | pmid=24120337 | doi=10.1016/j.gie.2013.07.019 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24120337  }} </ref>
 
The benefits of decompression and entrostomy tube are as follows:
*Placement of a [[gastrostomy]] tube, allows patients with motility disorders to vent [[gastric]] contents, relieves [[symptoms]], and decreases the need of hospitalization for acute exacerbations of gastroparesis.
*Provides enteral nutrition in patients with weight loss of more than 10% during six months period.
*Diminishes the need of hospitilization in patients with refractory [[symptoms]].
 
===Types of feeding tubes===
{| class="wikitable"
! colspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Intubations for decompression and feeding in patients with gastroparesis
|-
!'''Type of access'''
!'''Advantages'''
!'''Disadvantages'''
|-
![[Nasogastric tube]]
|
* Used for gastric decompression in acute management
|
* Not meant for long term use
* Causes discomfort
|-
![[Gastrostomy]] tube
|
* Used for venting gastric contents and decreases vomiting
|
* Poor choice for feeding due to delayed gastric emptying
|-
!Jet-peg tube
|
* Provides [[Jejunum|jejunal]] feedings
|
* Migration into the stomach
 
* Pyloric stenosis
|-
!Dual [[gastrostomy]] and jejunostomy
|
* Two sites: One for feeding and one for venting
|
* Increased risk of infection and leakage
|}


===Jejunostomy===
===Jejunostomy===
If a liquid or pureed diet does not work, you may need surgery to insert a feeding tube. The tube, called a [[jejunostomy]], is inserted through the [[skin]] on your abdomen into the small intestine. The [[feeding tube]] bypasses the stomach and places nutrients and medication directly into the [[small intestine]]. These products are then digested and delivered to your bloodstream quickly. You will receive special liquid food to use with the tube. The jejunostomy is used only when gastroparesis is severe or the tube is necessary to stabilize blood glucose levels in people with [[diabetes]].
*[[Jejunostomy]] tube is inserted through the [[abdomen]] directly into the small bowel.<ref name="pmid18292033">{{cite journal| author=Igaz P, Tulassay Z| title=[Gastroparesis and its treatment options]. | journal=Orv Hetil | year= 2008 | volume= 149 | issue= 9 | pages= 393-8 | pmid=18292033 | doi=10.1556/OH.2008.28293 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18292033  }} </ref><ref name="pmid2513608">{{cite journal| author=Fonkalsrud EW, Pitt HA, Berquist WE, Ament ME| title=Surgical management of chronic intestinal pseudo-obstruction in infancy and childhood. | journal=Prog Pediatr Surg | year= 1989 | volume= 24 | issue=  | pages= 221-5 | pmid=2513608 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2513608  }} </ref>
*It bypasses the [[stomach]] and supplies [[nutrients]] straight into the [[small intestine]].  
*The [[nutrients]] are then [[digested]] and distributed to the [[bloodstream]] quickly.
 
===Video===
===Video===
The video illustrates the steps of jejunostomy tube placement.
The video illustrates the steps of jejunostomy tube placement.
{{#ev:youtube|f0ceH07d8t0}}
{{#ev:youtube|f0ceH07d8t0}}
===Gastric electrical stimulation===
Gastric electrical stimulator is a battery-operated device, surgically implanted into the patient's [[stomach]] which releases electrical impulses and helps relieve [[nausea and vomiting]]. It is the preferred modality of treatment in the following patients:<ref name="pmid22742875">{{cite journal| author=Guerci B, Bourgeois C, Bresler L, Scherrer ML, Böhme P| title=Gastric electrical stimulation for the treatment of diabetic gastroparesis. | journal=Diabetes Metab | year= 2012 | volume= 38 | issue= 5 | pages= 393-402 | pmid=22742875 | doi=10.1016/j.diabet.2012.05.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22742875  }} </ref><ref name="pmid23074486">{{cite journal| author=Health Quality Ontario| title=Gastric electrical stimulation: an evidence-based analysis. | journal=Ont Health Technol Assess Ser | year= 2006 | volume= 6 | issue= 16 | pages= 1-79 | pmid=23074486 | doi= | pmc=3413096 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23074486  }} </ref>
*Patients with [[symptoms]] refractory to medical therapy for at least one year.
*It is beneficial for [[diabetics]] as it improves [[symptom]] serverity.
===Video===
The following video demonstrates the procedure of gastric electrical stimulation.
{{#ev:youtube|-S_JKjtQXUc}}


==References==
==References==

Latest revision as of 16:24, 20 February 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Feham Tariq, MD [2]

Overview

Surgical treatment is rarely indicated for the treatment of gastroparesis, however it can be useful in patients with persistent symptoms despite medical management.

Surgery

Surgical treatment is rarely indicated for the treatment of gastroparesis, however it can be useful in patients with persistent symptoms despite medical management.

Surgical techniques

Following surgical options are available for the surgical management of gastroparesis:[1][2][3][4][5][6][7][8][9][10][11]

Decompression and enterostomy tube placement

A percutaneous endoscopic gastrostomy tube is used to decompress the upper gastrointestinal tract.[12]

The benefits of decompression and entrostomy tube are as follows:

  • Placement of a gastrostomy tube, allows patients with motility disorders to vent gastric contents, relieves symptoms, and decreases the need of hospitalization for acute exacerbations of gastroparesis.
  • Provides enteral nutrition in patients with weight loss of more than 10% during six months period.
  • Diminishes the need of hospitilization in patients with refractory symptoms.

Types of feeding tubes

Intubations for decompression and feeding in patients with gastroparesis
Type of access Advantages Disadvantages
Nasogastric tube
  • Used for gastric decompression in acute management
  • Not meant for long term use
  • Causes discomfort
Gastrostomy tube
  • Used for venting gastric contents and decreases vomiting
  • Poor choice for feeding due to delayed gastric emptying
Jet-peg tube
  • Migration into the stomach
  • Pyloric stenosis
Dual gastrostomy and jejunostomy
  • Two sites: One for feeding and one for venting
  • Increased risk of infection and leakage

Jejunostomy

Video

The video illustrates the steps of jejunostomy tube placement. {{#ev:youtube|f0ceH07d8t0}}

Gastric electrical stimulation

Gastric electrical stimulator is a battery-operated device, surgically implanted into the patient's stomach which releases electrical impulses and helps relieve nausea and vomiting. It is the preferred modality of treatment in the following patients:[15][16]

  • Patients with symptoms refractory to medical therapy for at least one year.
  • It is beneficial for diabetics as it improves symptom serverity.

Video

The following video demonstrates the procedure of gastric electrical stimulation. {{#ev:youtube|-S_JKjtQXUc}}

References

  1. ↑ Pitt HA, Mann LL, Berquist WE, Ament ME, Fonkalsrud EW, DenBesten L (1985). "Chronic intestinal pseudo-obstruction. Management with total parenteral nutrition and a venting enterostomy". Arch Surg. 120 (5): 614–8. PMID 3921005.
  2. ↑ Murr MM, Sarr MG, Camilleri M (1995). "The surgeon's role in the treatment of chronic intestinal pseudoobstruction". Am J Gastroenterol. 90 (12): 2147–51. PMID 8540505.
  3. ↑ Shibata C, Naito H, Funayama Y, Fukushima K, Hashimoto A, Kitayama T; et al. (2003). "Surgical treatment of chronic intestinal pseudo-obstruction: report of three cases". Surg Today. 33 (1): 58–61. doi:10.1007/s005950300011. PMID 12560910.
  4. ↑ Kim HY, Kim JH, Jung SE, Lee SC, Park KW, Kim WK (2005). "Surgical treatment and prognosis of chronic intestinal pseudo-obstruction in children". J Pediatr Surg. 40 (11): 1753–9. doi:10.1016/j.jpedsurg.2005.07.046. PMID 16291165.
  5. ↑ Jones MP, Maganti K (2003). "A systematic review of surgical therapy for gastroparesis". Am J Gastroenterol. 98 (10): 2122–9. doi:10.1111/j.1572-0241.2003.07721.x. PMID 14572555.
  6. ↑ Karlstrom L, Kelly KA (1989). "Roux-Y gastrectomy for chronic gastric atony". Am J Surg. 157 (1): 44–9. PMID 2910126.
  7. ↑ Camilleri M, Parkman HP, Shafi MA, Abell TL, Gerson L, American College of Gastroenterology (2013). "Clinical guideline: management of gastroparesis". Am J Gastroenterol. 108 (1): 18–37, quiz 38. doi:10.1038/ajg.2012.373. PMC 3722580. PMID 23147521.
  8. ↑ Fontana RJ, Barnett JL (1996). "Jejunostomy tube placement in refractory diabetic gastroparesis: a retrospective review". Am J Gastroenterol. 91 (10): 2174–8. PMID 8855743.
  9. ↑ Pang B, Zhou Q, Li JL, Zhao LH, Tong XL (2014). "Treatment of refractory diabetic gastroparesis: Western medicine and traditional Chinese medicine therapies". World J Gastroenterol. 20 (21): 6504–14. doi:10.3748/wjg.v20.i21.6504. PMC 4047335. PMID 24914371.
  10. ↑ Chaves DM, de Moura EG, Mestieri LH, Artifon EL, Sakai P (2014). "Endoscopic pyloromyotomy via a gastric submucosal tunnel dissection for the treatment of gastroparesis after surgical vagal lesion". Gastrointest Endosc. 80 (1): 164. doi:10.1016/j.gie.2014.03.045. PMID 24836745.
  11. ↑ Mancini SA, Angelo JL, Peckler Z, Philp FH, Farah KF (2015). "Pyloroplasty for Refractory Gastroparesis". Am Surg. 81 (7): 738–46. PMID 26140897.
  12. ↑ Khashab MA, Stein E, Clarke JO, Saxena P, Kumbhari V, Chander Roland B; et al. (2013). "Gastric peroral endoscopic myotomy for refractory gastroparesis: first human endoscopic pyloromyotomy (with video)". Gastrointest Endosc. 78 (5): 764–8. doi:10.1016/j.gie.2013.07.019. PMID 24120337.
  13. ↑ Igaz P, Tulassay Z (2008). "[Gastroparesis and its treatment options]". Orv Hetil. 149 (9): 393–8. doi:10.1556/OH.2008.28293. PMID 18292033.
  14. ↑ Fonkalsrud EW, Pitt HA, Berquist WE, Ament ME (1989). "Surgical management of chronic intestinal pseudo-obstruction in infancy and childhood". Prog Pediatr Surg. 24: 221–5. PMID 2513608.
  15. ↑ Guerci B, Bourgeois C, Bresler L, Scherrer ML, Böhme P (2012). "Gastric electrical stimulation for the treatment of diabetic gastroparesis". Diabetes Metab. 38 (5): 393–402. doi:10.1016/j.diabet.2012.05.001. PMID 22742875.
  16. ↑ Health Quality Ontario (2006). "Gastric electrical stimulation: an evidence-based analysis". Ont Health Technol Assess Ser. 6 (16): 1–79. PMC 3413096. PMID 23074486.

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