Best Treatment for Gastroparesis?
Question of The Week from Debbie in Houston:
“I have gastroparesis and I am not responding to medication. My GI doctor recommended that I have pyloroplasty done. While I know this will not cure the gastroparesis, what other recommendations do you have to treat it? I am meeting with the surgeon next Friday. I have a list of questions written down. What do you think I should ask him? My GI doctor told me my other options are a gastric pacemaker or eventually I am going to be put on a feeding tube. I am not holding a lot of food down. I am nauseous every time I eat, I’ve been drinking a lot of Ensure. I need some kind of relief. I don’t know what to do.”
A number of years ago I developed a very effective surgery for severe refractory gastroparesis and published the case study: Laparoscopic longitudinal gastrectomy and duodenojejunostomy for treatment of diabetic gastroparesis. I have subsequently applied the same concept (without the duodenojejunostomy) on around 10 cases of severe gastroparesis and has had the same success: complete gastroparesis symptom elimination. I have followed some of these patients for years and they remained symptom free.
Consequently, I may be a bit biased when it comes to recommendations for best treatment for gastroparesis. However, mechanical drainage, like pyloroplasty and gastro-jejunostomy, of an atonic stomach is not likely to work at least from a theoretical point of view. Gastric pacemakers are proven ineffective for gastroparesis treatment in randomized studies. Subtotal gastrectomy for gastroparesis has been historically associated with poor outcomes while gastric bypass studies show suboptimal results.
I wish I have more than 10 patients with gastroparesis who have underwent an antrum preserving longitudinal gastrectomy to prove my concept. In the absence of such evidence, my procedure is still experimental. However, an antrum preserving longitudinal gastrectomy makes more sense to me than a pyloroplasty.