ReviewEffect of endoscopic pyloric therapies for patients with nausea and vomiting and functional obstructive gastroparesis

•We identified a subset of patients with functional obstructive gastroparesis.•These patients had normal 3 cpm gastric myoelectrical activity and normal endoscopy.•33 patients had at least one pyloric Botox injection or pyloric balloon dilation.•Overall, 78% of the 33 patients reported improvement in gastroparesis symptoms.•Average weight gain was 1.54 lb from baseline to final treatment (p < 0.04).

Gastroparesis (GP) is associated with loss of interstitial cells of Cajal (ICCs) and gastric dysrhythmias such as tachygastria. We hypothesized that a subset of patients with GP, normal 3 cycles per minute (cpm) gastric myoelectrical activity (GMA), and normal upper endoscopy may respond to pyloric therapies.AimsTo determine the effect of botulinum toxin A (btA) injection or balloon dilation (BD) of the pylorus on symptoms and body weight in patients with GP and 3 cpm GMA.MethodsPatients were identified who had GP, normal 3 cpm GMA, and normal endoscopy that excluded mechanical obstruction of the pylorus. Electrogastrograms (EGG) with water load tests (WLT) were recorded to determine GMA. Gastric emptying was measured with 4 h scintigraphy. Each patient underwent up to three pyloric treatments with btA or BD.ResultsThirty-three patients (29 women) with an average age of 42 years were studied. Seventy-nine percent had idiopathic GP and 21% had diabetic GP. The average percent meal retained at 4 h was 42% and each EGG test showed normal 3 cpm GMA. Nausea was the major symptom in 76% of patients. Complete or partial symptom response occurred in 75%, 72%, and 88% of patients after the first, second, or third endoscopic pyloric treatment, respectively. Overall, 78% of the 33 patients reported improvement in symptoms and average weight gain was 1.54 lb from baseline to final treatment (p < 0.04).ConclusionPyloric therapies appear to be effective treatments in symptomatic patients with GP and 3 cpm GMA and controlled trials are warranted.