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Efficacy and safety of endoscopic pyloric balloon dilation in patients with refractory gastroparesis

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Abstract

Background and aims

There has been interest in the use of pyloric therapies for the treatment of refractory gastroparesis. However, data on endoscopic pyloric dilation are scarce. We aimed to assess the efficacy and safety of this procedure in refractory gastroparesis.

Methods

We performed a retrospective analysis of 47 patients referred for refractory gastroparesis, confirmed by gastric emptying scintigraphy, and treated with endoscopic pyloric through-the-scope balloon dilation. The primary endpoint was the effectiveness of the procedure, evaluated with the Gastric Cardinal Symptom Index (GCSI) at 2 and 6 months.

Results

A clinical response, defined by a 1.0 point decrease in the GCSI score, was observed in 25 patients at 2 months (53%) and in 19 patients at 6 months (40%). The mean GCSI score decreased significantly at 2 and 6 months compared to the preoperative score (3.9 ± 0.87 vs 2.3 ± 1.37 and 3.9 ± 0.87 vs 2.9 ± 1.27, respectively; p < 0.0001). No complication was observed. Nine patients had a delayed relapse at 1 year. A second dilation was performed for eight patients and it was effective in five of them (63%). The mean follow-up time of the patients was 27.0 ± 10.4 months. At 2 years, 15 patients still experienced improvement following this treatment (32%). No predictive factor of clinical response was identified.

Conclusion

The efficacy of pyloric dilation is 53% at 2 months, with sustained improvement in one third of patients at 2 years. This treatment should be considered as an alternative option to pyloromyotomy.

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Author notes

  1. Heithem Soliman, Elsa Oiknine both contributed equally to this work.

Authors and Affiliations

  1. Centre de Recherche Sur L’Inflammation, Université de Paris Cité, Inserm UMRS 1149, 75018, Paris, France

    Heithem Soliman, Maude Le Gall, Benoit Coffin & Henri Duboc

  2. Hépato Gastro Entérologie, Hôpital Louis Mourier, DMU ESPRIT - GHU (AP-HP), 178 rue des Renouillers, 92700, Colombes, France

    Heithem Soliman, Elsa Oiknine, Boris Cohen-Sors, Caroline Gorbatchef, Marie Dior, Nicoleta Nebunu, Benoit Coffin & Henri Duboc

  3. Service de Chirurgie Générale Et Digestive, AP-HP, Hôpital Louis Mourier, DMU ESPRIT-GHU AP-HP, Nord-Université de Paris, 92700, Colombes, France

    David Moszkowicz

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Correspondence to Heithem Soliman.

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All the authors have no conflicts of interest, or financial ties to disclose. HS has no conflict of intersts, or ties to disclose. EO has no conflict of interests, or ties to disclose. BCS has no conflict of interests, or ties to disclose. DM has no conflict of interests, or ties to disclose. CG has no conflict of interests, or ties to disclose. MD has no conflict of interests, or ties to disclose. NN has no conflict of interests, or ties to disclose. MLG has no conflict of interests, or ties to disclose. BC has no conflict of interests, or ties to disclose. HD has no conflict of interests, or ties to disclose.

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Soliman, H., Oiknine, E., Cohen-Sors, B. et al. Efficacy and safety of endoscopic pyloric balloon dilation in patients with refractory gastroparesis. Surg Endosc 36, 8012–8020 (2022). https://doi.org/10.1007/s00464-022-09230-w

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