Karen from Houston sent us this question: “Hello, my name is Karen. I am a 21-year-old female who suffers from gastroparesis. The LINX™ device caused my gastroparesis. I got it removed and now have a Nissen fundoplication. But still suffer with GP. Is there hope for me besides medication? I’ve heard that the G-POEM procedure can cause dumping syndrome. So, I didn’t want to get that surgery. Is there a safer and better option than G-POEM?”
Dear Karen,
Injuring the vagus nerve during hiatal hernia repair or LINX™ surgery may result in delayed gastric emptying or gastroparesis. Conversion of LINX™ to Nissen fundoplication improves gastric emptying. However, Nissen fundoplication by itself may not be enough to normalize gastric emptying. The traditional recommendation is to add a pyloroplasty (cutting the pyloric muscle that controls stomach outlet) to improve stomach drainage. However, this approach is neither reliable nor effective. G-POEM is pyloroplasty performed through the mouth using endoscopy. Although many publications in the literature show promising results, G-POEM is as unreliable as laparoscopic pyloroplasty. The pylorus is not narrowed in gastroparesis and therefore, cutting open the pylorus to promote stomach drainage neither results in improved gastric emptying nor gastroparesis symptom resolution. Therefore, dumping or accelerated gastric emptying, is not likely to occur following G-POEM. Indeed, G-POEM increases the risk of bile reflux from duodenum into stomach. Bile accumulation in stomach causes bile gastritis (stomach inflammation) and esophagitis (esophagus inflammation).
At Houston Heartburn and Reflux Center, we have developed a novel treatment for gastroparesis: an antrum preserving longitudinal gastrectomy. The procedure is both safe and reliable. In cases of vagal nerve injury where a Nissen fundoplication has already been constructed, the resection stops just below the level of the wrap with no need to take down the fundoplication. We have achieved great outcomes with this procedure that normalizes gastric emptying and alleviates nausea and vomiting. Should you have any questions about gastroparesis management following anti-reflux surgery please give us a call at 832-945-8717.