Abstract
Gastric emptying is a highly regulated process reflecting the integration of the propulsive forces of proximal fundic tone and distal antral contractions with the functional resistance provided by the pyloric sphincter. Gastroparesis is a complex syndrome with a variety of potential underlying mechanisms, among which are abnormalities in fundic accommodation, gastric arrhythmia, impaired antral contractility, abnormalities of the small bowel with resultant abnormal gastric feedback, vagal injury/neuropathy, and pyloric dysfunction. Importantly, patients can be affected by more than one mechanism, perhaps explaining why data on the treatment of gastroparesis has been mixed. Patients with gastroparesis (delayed gastric emptying) have symptoms of nausea, vomiting, early satiety, postprandial fullness, and abdominal discomfort. Treatment begins with dietary modifications, prokinetic medications, and/or antiemetic medications. For patients remaining to be symptomatic, other treatments may involve surgical treatments such as gastric electric stimulator placement, pyloroplasty/pyloromyotomy, as well as endoscopic pyloric treatments such as botulinum injection, balloon dilation, and pyloromyotomy.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Bibliography
Miller LS, Szych GA, Kantor SB, et al. Treatment of idiopathic gastroparesis with injection of botulinum toxin into the pyloric sphincter muscle. Am J Gastroenterol. 2002;97:1653–60.
Bromer MQ, Friedenberg F, Miller LS, et al. Endoscopic pyloric injection of botulinum toxin A for the treatment of refractory gastroparesis. Gastrointest Endosc. 2005;61:833–9.
Arts J, Holvoet L, Caenepeel P, et al. Clinical trial: a randomized-controlled crossover study of intrapyloric injection of botulinum toxin in gastroparesis. Aliment Pharmacol Ther. 2007;26:1251–8.
Friedenberg FK, Palit A, Parkman HP, et al. Botulinum toxin A for the treatment of delayed gastric emptying. Am J Gastroenterol. 2008;103:416–23.
Coleski R, et al. Factors associated with symptoms response to pyloric injection of botulinum toxin in a large series of gastroparesis patients. Dig Dis Sci. 2009;54:2634–42.
Ukleja A, Tandon K, Shah K, Alvarez A. Endoscopic Botox injections in therapy of refractory gastroparesis. World J Gastrointest Endosc. 2015;7:790–8.
Reichenbach ZW, Stanek S, Patel S, Ward SJ, Malik Z, Parkman HP, Schey R. Botulinum toxin A improves symptoms of gastroparesis. Dig Dis Sci. 2020;65:1396–404.
Malik Z, Kataria R, Modayil R, Ehrlich AC, Schey R, Parkman HP, Stavropoulos SN. Gastric per oral endoscopic myotomy (G-POEM) for the treatment of refractory gastroparesis: early experience. Dig Dis Sci. 2018;63:2405–12.
Desprez C, Melchior C, Wuestenberghs F, Zalar A, Jacques J, Leroi AM, Gourcerol G. Pyloric distensibility measurement predicts symptomatic response to intrapyloric botulinum toxin injection. Gastrointest Endosc. 2019;90:754–760.e1.
Soliman H, Oiknine E, Cohen-Sors B, Moszkowicz D, Gorbatchef C, Dior M, Nebunu N, Le Gall M, Coffin B, Duboc H. Efficacy and safety of endoscopic pyloric balloon dilation in patients with refractory gastroparesis. Surg Endosc. 2022; https://doi.org/10.1007/s00464-022-09230-w.
Murray FR, Schindler V, Hente JM, Fischbach LM, Schnurre L, Deibel A, Hildenbrand FF, Tatu AM, Pohl D. Pyloric dilation with the esophageal functional lumen imaging probe in gastroparesis improves gastric emptying, pyloric distensibility, and symptoms. Gastrointest Endosc. 2021;94:486–94.
Jehangir A, Malik Z, Petrov RV, Parkman HP. EndoFLIP and pyloric dilation for gastroparesis symptoms refractory to pyloromyotomy/pyloroplasty. Dig Dis Sci. 2021;66:2682–90.
Clarke JO, Sharaiha RZ, Kord Valeshabad A, et al. Through-the-scope transpyloric stent placement improves symptoms and gastric emptying in patients with gastroparesis. Endoscopy. 2013;45(Suppl 2 UCTN):E189–90.
Khashab MA, Besharati S, Ngamruengphong S, et al. Refractory gastroparesis can be successfully managed with endoscopic transpyloric stent placement and fixation (with video). Gastrointest Endosc. 2015;82:1106–9.
Brewer Gutierrez OI, Khashab MA. Stent placement for the treatment of gastroparesis. Gastrointest Endosc Clin N Am. 2019;29:107–15.
Khashab MA, Stein E, Clarke JO, et al. Gastric peroral endoscopic myotomy for refractory gastroparesis: first human endoscopic pyloromyotomy (with video). Gastrointest Endosc. 2013;78:764–8.
Vosoughi K, Ichkhanian Y, Benias P, et al. Gastric per-oral endoscopic myotomy (G-POEM) for refractory gastroparesis: results from an international prospective trial. Gut. 2022;71:25–33.
Khashab MA, Baker JR, Roesch T. What is missing before gastric peroral endoscopic myotomy can go mainstream for treatment of gastroparesis? Clin Gastroenterol Hepatol. 2021;19:662–4.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Brewer Gutierrez, O.I., Khashab, M.A., Parkman, H.P. (2023). Endoscopic Pyloric Therapies for Gastroparesis. In: Nguyen, N.T., et al. The AFS Textbook of Foregut Disease. Springer, Cham. https://doi.org/10.1007/978-3-031-19671-3_43
Download citation
DOI: https://doi.org/10.1007/978-3-031-19671-3_43
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-19670-6
Online ISBN: 978-3-031-19671-3
eBook Packages: MedicineMedicine (R0)