Gastroparesis surgery: Difference between revisions
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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 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> | 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 such as gastrostomy or jejunostomy tube | *Placement of an entrostomy tube such as gastrostomy or jejunostomy tube | ||
*Surgical pyloroplasty | *Surgical pyloroplasty | ||
Revision as of 15:30, 8 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]
- Placement of an entrostomy tube such as gastrostomy or jejunostomy tube
- Surgical pyloroplasty
- Subtotal gastrectomy
- Endoscopic pyloromyotomy (gastric per-oral endoscopic myotomy)
- Laparoscopic pyloroplasty
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 |
|
| Gastrostomy tube | Used for venting gastric contents and decreases vomiting | Poor choice for feeding due to delayed gastric emptying |
| Jet-peg tube | Provides jejunal feedings |
|
| Dual gastrostomy and jejunostomy | Two sites: One for feeding and one for venting. | Increased risk of infection and leakage |
Jejunostomy
- Jejunostomy tube is inserted through the abdomen directly into the small bowel.
- It bypasses the stomach and feeds nutrients straight into the small intestine.
- The nutrients are then digested and distributed to the bloodstream quickly.
Video
The video illustrates the steps of jejunostomy tube placement. {{#ev:youtube|f0ceH07d8t0}}
References
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Karlstrom L, Kelly KA (1989). "Roux-Y gastrectomy for chronic gastric atony". Am J Surg. 157 (1): 44–9. PMID 2910126.
- ↑ 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.
- ↑ Fontana RJ, Barnett JL (1996). "Jejunostomy tube placement in refractory diabetic gastroparesis: a retrospective review". Am J Gastroenterol. 91 (10): 2174–8. PMID 8855743.
- ↑ 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.
- ↑ 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.
- ↑ Mancini SA, Angelo JL, Peckler Z, Philp FH, Farah KF (2015). "Pyloroplasty for Refractory Gastroparesis". Am Surg. 81 (7): 738–46. PMID 26140897.
- ↑ 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.