End of the Road for a Dysfunctional End Organ: Laparoscopic Gastrectomy for Refractory Gastroparesis
Introduction Gastroparesis is a functional disorder resulting in debilitating nausea, esophageal reflux, and abdominal pain and is frequently refractory to medical treatment. Therapies such as pyloroplasty and neurostimulators can improve symptoms. When medical and surgical treatments fail, palliati...
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| Veröffentlicht in: | Journal of gastrointestinal surgery 2015-03, Vol.19 (3), p.411-417 |
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| creator | Bhayani, Neil H. Sharata, Ahmed M. Dunst, Christy M. Kurian, Ashwin A. Reavis, Kevin M. Swanstrom, Lee L. |
| description | Introduction
Gastroparesis is a functional disorder resulting in debilitating nausea, esophageal reflux, and abdominal pain and is frequently refractory to medical treatment. Therapies such as pyloroplasty and neurostimulators can improve symptoms. When medical and surgical treatments fail, palliative gastrectomy is an option. We examined outcomes after gastrectomy for postoperative, diabetic, and idiopathic gastroparesis.
Methods
A prospective database was queried for gastrectomies performed for gastroparesis from 1999 to 2013. Primary outcomes were improvements in pre- versus postoperative symptoms at last follow-up, measured on a five-point scale. Secondary outcome was operative morbidity.
Results
Thirty-five patients underwent laparoscopic total or near-total gastrectomies for postoperative (43 %), diabetic (34 %), or idiopathic (23 %) gastroparesis. Antiemetics and prokinetics afforded minimal relief for one third of patients. There were no mortalities. Six patients suffered a leak, all treated with surgical reintervention. With a median follow-up of 6 months, nausea improved or resolved in 69 %. Chronic abdominal pain improved or resolved in 70 %. Belching and bloating resolved for 79 and 89 %, respectively (
p
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| doi_str_mv | 10.1007/s11605-014-2609-y |
| format | Article |
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Gastroparesis is a functional disorder resulting in debilitating nausea, esophageal reflux, and abdominal pain and is frequently refractory to medical treatment. Therapies such as pyloroplasty and neurostimulators can improve symptoms. When medical and surgical treatments fail, palliative gastrectomy is an option. We examined outcomes after gastrectomy for postoperative, diabetic, and idiopathic gastroparesis.
Methods
A prospective database was queried for gastrectomies performed for gastroparesis from 1999 to 2013. Primary outcomes were improvements in pre- versus postoperative symptoms at last follow-up, measured on a five-point scale. Secondary outcome was operative morbidity.
Results
Thirty-five patients underwent laparoscopic total or near-total gastrectomies for postoperative (43 %), diabetic (34 %), or idiopathic (23 %) gastroparesis. Antiemetics and prokinetics afforded minimal relief for one third of patients. There were no mortalities. Six patients suffered a leak, all treated with surgical reintervention. With a median follow-up of 6 months, nausea improved or resolved in 69 %. Chronic abdominal pain improved or resolved in 70 %. Belching and bloating resolved for 79 and 89 %, respectively (
p
< 0.01).
Conclusions
Regardless of etiology, medically refractory gastroparesis can be a devastating disease. Near-total gastrectomy can ameliorate or relieve nausea, belching, and bloating. Chronic abdominal pain commonly resolved or improved with resection. Despite attendant morbidity, gastrectomy can effectively palliate symptoms of gastroparesis.</description><identifier>ISSN: 1091-255X</identifier><identifier>EISSN: 1873-4626</identifier><identifier>DOI: 10.1007/s11605-014-2609-y</identifier><identifier>PMID: 25575765</identifier><language>eng</language><publisher>Boston: Springer US</publisher><subject>2014 SSAT Plenary Presentation ; Abdomen ; Abdominal Pain - surgery ; Antiemetics ; Diabetes ; Diabetes Complications - complications ; Diabetes Complications - surgery ; Eructation - surgery ; Female ; Gastrectomy - methods ; Gastroenterology ; Gastroesophageal Reflux - surgery ; Gastrointestinal surgery ; Gastroparesis - drug therapy ; Gastroparesis - etiology ; Gastroparesis - surgery ; Humans ; Laparoscopy ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Morbidity ; Nausea ; Nausea - surgery ; Pain ; Postoperative Complications - surgery ; Questionnaires ; Retreatment ; Severity of Illness Index ; Surgery ; Treatment Outcome</subject><ispartof>Journal of gastrointestinal surgery, 2015-03, Vol.19 (3), p.411-417</ispartof><rights>The Society for Surgery of the Alimentary Tract 2015</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-11589403ef9018d55b5c770d94423e59c6339579420013f8e3cfb5b7613787f3</citedby><cites>FETCH-LOGICAL-c372t-11589403ef9018d55b5c770d94423e59c6339579420013f8e3cfb5b7613787f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11605-014-2609-y$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11605-014-2609-y$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51298</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25575765$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bhayani, Neil H.</creatorcontrib><creatorcontrib>Sharata, Ahmed M.</creatorcontrib><creatorcontrib>Dunst, Christy M.</creatorcontrib><creatorcontrib>Kurian, Ashwin A.</creatorcontrib><creatorcontrib>Reavis, Kevin M.</creatorcontrib><creatorcontrib>Swanstrom, Lee L.</creatorcontrib><title>End of the Road for a Dysfunctional End Organ: Laparoscopic Gastrectomy for Refractory Gastroparesis</title><title>Journal of gastrointestinal surgery</title><addtitle>J Gastrointest Surg</addtitle><addtitle>J Gastrointest Surg</addtitle><description>Introduction
Gastroparesis is a functional disorder resulting in debilitating nausea, esophageal reflux, and abdominal pain and is frequently refractory to medical treatment. Therapies such as pyloroplasty and neurostimulators can improve symptoms. When medical and surgical treatments fail, palliative gastrectomy is an option. We examined outcomes after gastrectomy for postoperative, diabetic, and idiopathic gastroparesis.
Methods
A prospective database was queried for gastrectomies performed for gastroparesis from 1999 to 2013. Primary outcomes were improvements in pre- versus postoperative symptoms at last follow-up, measured on a five-point scale. Secondary outcome was operative morbidity.
Results
Thirty-five patients underwent laparoscopic total or near-total gastrectomies for postoperative (43 %), diabetic (34 %), or idiopathic (23 %) gastroparesis. Antiemetics and prokinetics afforded minimal relief for one third of patients. There were no mortalities. Six patients suffered a leak, all treated with surgical reintervention. With a median follow-up of 6 months, nausea improved or resolved in 69 %. Chronic abdominal pain improved or resolved in 70 %. Belching and bloating resolved for 79 and 89 %, respectively (
p
< 0.01).
Conclusions
Regardless of etiology, medically refractory gastroparesis can be a devastating disease. Near-total gastrectomy can ameliorate or relieve nausea, belching, and bloating. Chronic abdominal pain commonly resolved or improved with resection. Despite attendant morbidity, gastrectomy can effectively palliate symptoms of gastroparesis.</description><subject>2014 SSAT Plenary Presentation</subject><subject>Abdomen</subject><subject>Abdominal Pain - surgery</subject><subject>Antiemetics</subject><subject>Diabetes</subject><subject>Diabetes Complications - complications</subject><subject>Diabetes Complications - surgery</subject><subject>Eructation - surgery</subject><subject>Female</subject><subject>Gastrectomy - methods</subject><subject>Gastroenterology</subject><subject>Gastroesophageal Reflux - surgery</subject><subject>Gastrointestinal surgery</subject><subject>Gastroparesis - drug therapy</subject><subject>Gastroparesis - etiology</subject><subject>Gastroparesis - surgery</subject><subject>Humans</subject><subject>Laparoscopy</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>Nausea</subject><subject>Nausea - surgery</subject><subject>Pain</subject><subject>Postoperative Complications - surgery</subject><subject>Questionnaires</subject><subject>Retreatment</subject><subject>Severity of Illness Index</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><issn>1091-255X</issn><issn>1873-4626</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kUtPAyEUhYnRaK3-ADeGxI2bUe4wwODO1PpImpg0XbgjlAEd0w4VZhbz76VONcbEFY_73XM5HITOgFwBIeI6AnDCMgJFlnMis34PjaAUNCt4zvfTnkjIcsZejtBxjO-EgCBQHqKjdCeY4GyEqmlTYe9w-2bx3OsKOx-wxnd9dF1j2to3eoW3zHN41c0NnumNDj4av6kNftCxDda0ft1_9c2tCzodQz-UfGJtrOMJOnB6Fe3pbh2jxf10MXnMZs8PT5PbWWaoyNsMgJWyINQ6mZ5ZMbZkRghSyaLIqWXScEolE7LIkxPqSkuNW7Kl4EBFKRwdo8tBdhP8R2djq9Z1NHa10o31XVTAmaBQCCISevEHffddSF6_KMaFZFAkCgbKJMsxWKc2oV7r0CsgapuAGhJQKQG1TUD1qed8p9wt17b66fj-8gTkAxBTqXm14dfof1U_AZiMj8I</recordid><startdate>20150301</startdate><enddate>20150301</enddate><creator>Bhayani, Neil H.</creator><creator>Sharata, Ahmed M.</creator><creator>Dunst, Christy M.</creator><creator>Kurian, Ashwin A.</creator><creator>Reavis, Kevin M.</creator><creator>Swanstrom, Lee L.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20150301</creationdate><title>End of the Road for a Dysfunctional End Organ: Laparoscopic Gastrectomy for Refractory Gastroparesis</title><author>Bhayani, Neil H. ; Sharata, Ahmed M. ; Dunst, Christy M. ; Kurian, Ashwin A. ; Reavis, Kevin M. ; Swanstrom, Lee L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-11589403ef9018d55b5c770d94423e59c6339579420013f8e3cfb5b7613787f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>2014 SSAT Plenary Presentation</topic><topic>Abdomen</topic><topic>Abdominal Pain - surgery</topic><topic>Antiemetics</topic><topic>Diabetes</topic><topic>Diabetes Complications - complications</topic><topic>Diabetes Complications - surgery</topic><topic>Eructation - surgery</topic><topic>Female</topic><topic>Gastrectomy - methods</topic><topic>Gastroenterology</topic><topic>Gastroesophageal Reflux - surgery</topic><topic>Gastrointestinal surgery</topic><topic>Gastroparesis - drug therapy</topic><topic>Gastroparesis - etiology</topic><topic>Gastroparesis - surgery</topic><topic>Humans</topic><topic>Laparoscopy</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Morbidity</topic><topic>Nausea</topic><topic>Nausea - surgery</topic><topic>Pain</topic><topic>Postoperative Complications - surgery</topic><topic>Questionnaires</topic><topic>Retreatment</topic><topic>Severity of Illness Index</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bhayani, Neil H.</creatorcontrib><creatorcontrib>Sharata, Ahmed M.</creatorcontrib><creatorcontrib>Dunst, Christy M.</creatorcontrib><creatorcontrib>Kurian, Ashwin A.</creatorcontrib><creatorcontrib>Reavis, Kevin M.</creatorcontrib><creatorcontrib>Swanstrom, Lee L.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of gastrointestinal surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bhayani, Neil H.</au><au>Sharata, Ahmed M.</au><au>Dunst, Christy M.</au><au>Kurian, Ashwin A.</au><au>Reavis, Kevin M.</au><au>Swanstrom, Lee L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>End of the Road for a Dysfunctional End Organ: Laparoscopic Gastrectomy for Refractory Gastroparesis</atitle><jtitle>Journal of gastrointestinal surgery</jtitle><stitle>J Gastrointest Surg</stitle><addtitle>J Gastrointest Surg</addtitle><date>2015-03-01</date><risdate>2015</risdate><volume>19</volume><issue>3</issue><spage>411</spage><epage>417</epage><pages>411-417</pages><issn>1091-255X</issn><eissn>1873-4626</eissn><abstract>Introduction
Gastroparesis is a functional disorder resulting in debilitating nausea, esophageal reflux, and abdominal pain and is frequently refractory to medical treatment. Therapies such as pyloroplasty and neurostimulators can improve symptoms. When medical and surgical treatments fail, palliative gastrectomy is an option. We examined outcomes after gastrectomy for postoperative, diabetic, and idiopathic gastroparesis.
Methods
A prospective database was queried for gastrectomies performed for gastroparesis from 1999 to 2013. Primary outcomes were improvements in pre- versus postoperative symptoms at last follow-up, measured on a five-point scale. Secondary outcome was operative morbidity.
Results
Thirty-five patients underwent laparoscopic total or near-total gastrectomies for postoperative (43 %), diabetic (34 %), or idiopathic (23 %) gastroparesis. Antiemetics and prokinetics afforded minimal relief for one third of patients. There were no mortalities. Six patients suffered a leak, all treated with surgical reintervention. With a median follow-up of 6 months, nausea improved or resolved in 69 %. Chronic abdominal pain improved or resolved in 70 %. Belching and bloating resolved for 79 and 89 %, respectively (
p
< 0.01).
Conclusions
Regardless of etiology, medically refractory gastroparesis can be a devastating disease. Near-total gastrectomy can ameliorate or relieve nausea, belching, and bloating. Chronic abdominal pain commonly resolved or improved with resection. Despite attendant morbidity, gastrectomy can effectively palliate symptoms of gastroparesis.</abstract><cop>Boston</cop><pub>Springer US</pub><pmid>25575765</pmid><doi>10.1007/s11605-014-2609-y</doi><tpages>7</tpages></addata></record> |
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| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | 2014 SSAT Plenary Presentation Abdomen Abdominal Pain - surgery Antiemetics Diabetes Diabetes Complications - complications Diabetes Complications - surgery Eructation - surgery Female Gastrectomy - methods Gastroenterology Gastroesophageal Reflux - surgery Gastrointestinal surgery Gastroparesis - drug therapy Gastroparesis - etiology Gastroparesis - surgery Humans Laparoscopy Male Medicine Medicine & Public Health Middle Aged Morbidity Nausea Nausea - surgery Pain Postoperative Complications - surgery Questionnaires Retreatment Severity of Illness Index Surgery Treatment Outcome |
| title | End of the Road for a Dysfunctional End Organ: Laparoscopic Gastrectomy for Refractory Gastroparesis |
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