Pyloroplasty for Refractory Gastroparesis

2015 ◽  
Vol 81 (7) ◽  
pp. 738-746 ◽  
Author(s):  
Sheri A. Mancini ◽  
Jillian L. Angelo ◽  
Zachary Peckler ◽  
Frances H. Philp ◽  
Katie F. Farah
Keyword(s):  
Quality Of Life ◽  
Gastric Emptying ◽  
Symptom Severity ◽  
Motility Disorder ◽  
Drainage Procedure ◽  
Symptom Index ◽  
Gastric Emptying Scintigraphy ◽  
Cardinal Symptom ◽  
Postoperative Interval

Gastroparesis is a chronic gastric motility disorder in which the pathophysiology mimics a post-vagotomy state. Pyloroplasty is beginning to emerge as a successful drainage procedure for refractory gastroparesis. Here we report our experience using pyloroplasty in the surgical management of diabetic and nondiabetic gastroparesis. A retrospective study was performed of 46 patients undergoing pyloroplasty for refractory gastroparesis from January 2010 through December 2013. Gastric emptying scintigraphy and the Gastroparesis Cardinal Symptom Index were assessed pre-and postoperatively. Laparoscopic pyloroplasty was performed in 42 patients, open pyloroplasty in three, and one patient was converted from laparoscopic to open pyloroplasty. Studies were repeated during the six to 12 month postoperative interval. The postoperative gastric emptying scintigraphy improved in 90 per cent of patients and normalized in 60 per cent. Postoperative T½ was significantly reduced ( P = 0.001) as was four-hour retention ( P < 0.001). The Gastroparesis Cardinal Symptom Index showed statistically significant reduction in symptom severity for all nine categories ( P < 0.0005) as well as total symptom score ( P < 0.005). No patients developed dumping syndrome. Pyloroplasty is a highly effective therapy for refractory gastroparesis, offering significant reduction in symptom severity, improvement in quality of life, and acceleration of gastric emptying.

Peroral endoscopic pyloromyotomy is efficacious and safe for refractory gastroparesis: prospective trial with assessment of pyloric function

Endoscopy ◽  
2018 ◽  
Vol 51 (01) ◽  
pp. 40-49 ◽  
Author(s):  
Jérémie Jacques ◽  
Lauriane Pagnon ◽  
Florent Hure ◽  
Romain Legros ◽  
Sabrina Crepin ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Gastric Emptying ◽  
Clinical Success ◽  
Prospective Trial ◽  
Area Under The Curve ◽  
Symptom Index ◽  
Imaging Probe ◽  
Quality Of Life Scale ◽  
Cardinal Symptom

Abstract Background Gastroparesis is a functional disorder with a variety of symptoms that is characterized by delayed gastric emptying in the absence of mechanical obstruction. A recent series of retrospective studies has demonstrated that peroral endoscopic pyloromyotomy (G-POEM) is a promising endoscopic procedure for treating patients with refractory gastroparesis. The aim of this prospective study was to evaluate the feasibility, safety, and efficacy of G-POEM. Methods 20 patients with refractory gastroparesis (10 diabetic and 10 nondiabetic) were prospectively included in the trial. Patients were treated by G-POEM after evaluation of pyloric function using an endoscopic functional luminal imaging probe. Clinical responses were evaluated using the Gastroparesis Cardinal Symptom Index (GCSI), and quality of life was assessed using the Patient Assessment of Upper Gastrointestinal Disorders – Quality of Life scale and the Gastrointestinal Quality of Life Index scores. Gastric emptying was measured using 4-hour scintigraphy before G-POEM and at 3 months. Results Feasibility of the procedure was 100 %. Compared with baseline values, G-POEM significantly improved symptoms (GCSI: 1.3 vs. 3.5; P < 0.001), quality of life, and gastric emptying (T½: 100 vs. 345 minutes, P < 0.001; %H2: 56.0 % vs. 81.5 %, P < 0.001; %H4: 15.0 % vs. 57.5 %, P = 0.003) at 3 months. The clinical success of G-POEM using the functional imaging probe inflated to 50 mL had specificity of 100 % and sensitivity of 72.2 % (P = 0.04; 95 % confidence interval 0.51 – 0.94; area under the curve 0.72) at a distensibility threshold of 9.2 mm2/mmHg. Conclusion G-POEM was efficacious and safe for treating refractory gastroparesis, especially in patients with low pyloric distensibility.

Symptom Severity and Quality of Life in Dyspeptics and Their Relationship to Gastric Emptying

2013 ◽  
Vol 108 ◽  
pp. S45
Author(s):  
Neal Patel ◽  
Michael Crowell ◽  
Amylou Dueck ◽  
Michael Roarke ◽  
John Dibaise
Keyword(s):  
Quality Of Life ◽  
Gastric Emptying ◽  
Symptom Severity

scholarly journals Peroral endoscopic pyloromyotomy for gastroparesis: a systematic review and meta-analysis

2020 ◽  
Vol 08 (07) ◽  
pp. E911-E923
Author(s):  
Karime Lucas Uemura ◽  
Dalton Chaves ◽  
Wanderley M. Bernardo ◽  
Ricardo Sato Uemura ◽  
Diogo Turiani Hourneaux de Moura ◽  
...  
Keyword(s):  
Systematic Review ◽  
Gastric Emptying ◽  
Solid Phase ◽  
Therapeutic Option ◽  
Meta Analysis ◽  
Mean Difference ◽  
Cochrane Library ◽  
Symptom Index ◽  
Gastric Emptying Scintigraphy ◽  
Cardinal Symptom

Abstract Background and aim Gastric peroral endoscopic pyloromyotomy (G-POEM) is a new therapeutic option for refractory gastroparesis (GP). A systematic review and meta-analysis was conducted to assess the effectiveness of G-POEM in refractory GP. For the quality of evidence, we used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Methods We performed a literature search using MEDLINE, Embase, Cochrane library, LILACS and the Science citation index for studies related to G-POEM from the inception of its technique through January 2019. We selected studies that analyzed the gastroparesis cardinal symptom index (GCSI) and 4-hour solid-phase gastric emptying scintigraphy (GES) before and after the procedure to verify the efficacy of G-POEM, the main outcome measured. An analysis was performed using RevMan 5.3. Results Ten studies comprising 281 patients were included in this systematic review. The pooled mean difference in GCSI following the procedure was 1.76 (95 % CI: [1.43, 2.08], I2 = 72 %). We also performed GCSI subgroup analysis by follow-up duration that showed a pooled mean difference of 1.84 (95 % CI: [1.57, 2.12], I2 = 71 %). The pooled mean difference in GES after the procedure was 26.28 (95 % CI: [19.74, 32.83], I2 = 87 %), corresponding to a significant drop in percentage values of the gastric retention 4-hour scintigraphy. Conclusion This meta-analysis demonstrates that G-POEM is effective and shows promising outcomes in the clinical response and gastric emptying scintigraphy for gastroparesis. Therefore, it should be considered in the management of refractory gastroparesis.

Symptoms of Gastroparesis: Use of the Gastroparesis Cardinal Symptom Index in Symptomatic Patients Referred for Gastric Emptying Scintigraphy

Digestion ◽  
2008 ◽  
Vol 78 (2-3) ◽  
pp. 144-151 ◽  
Author(s):  
Daniel W. Cassilly ◽  
Y. Richard Wang ◽  
Frank K. Friedenberg ◽  
Deborah B. Nelson ◽  
Alan H. Maurer ◽  
...  
Keyword(s):  
Gastric Emptying ◽  
Symptom Index ◽  
Gastric Emptying Scintigraphy ◽  
Cardinal Symptom

FC 112HEALTH-RELATED QUALITY OF LIFE (HRQOL) AND SYMPTOM BURDEN BEFORE AND AFTER START OF DIALYSIS IN OLDER PATIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Esther De Rooij ◽  
Yvette Meuleman ◽  
Johan W De Fijter ◽  
Kitty J Jager ◽  
Nicholas Chesnaye ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Symptom Severity ◽  
Symptom Burden ◽  
Dialysis Initiation ◽  
Older Individuals ◽  
Symptom Index ◽  
Before And After ◽  
Related Quality ◽  
Physical Hrqol

Abstract Background and Aims The number of older (≥65y) people with ESKD starting chronic dialysis increased substantially the past decade because of ageing of the population due to improved health care. In addition, older age is no longer a contraindication for dialysis. Finally, older individuals are more often ineligible for kidney transplantation. Many older people with stage 5 CKD non-dialysis have a low health-related quality of life (HRQOL) and high symptom burden. In this group, improving HRQOL and lowering symptom burden may be deemed more important than solely the prolongation of life. Little is known about the effect of dialysis treatment on HRQOL and symptom burden. Therefore, we investigated the evolution of HRQOL and symptoms before and after the start of dialysis in older ESKD patients. Method The European Quality (EQUAL) study is an ongoing European prospective multi-center follow-up study in late stage 4/5 CKD patients aged ≥65 years. For the present analyses, we included all patients who started dialysis. HRQOL was assessed every 3-6 months using the RAND-36 questionnaire, resulting in a physical component summary (PCS) and a mental component summary (MCS) score. Component scores ranged from 0-100 with higher scores indicating a better HRQOL. Kidney disease-related symptom burden was assessed every 3-6 months using the dialysis symptom index (DSI). The sum score for symptom number ranged from 0 to 30 and for symptom severity from 0 to 150, with higher scores indicating a higher symptom burden. We used linear mixed models (LMM) to explore the evolution of mental and physical HRQOL, symptom number and symptom severity during the year preceding and following dialysis initiation. Results In total, 571 older dialysis patients were included. At baseline (dialysis initiation), mean (SD) age was 76 (6) years, 74% were men, 47% had diabetes, 9% were current smokers, 34% had cardiovascular disease and the mean (SD) residual kidney function was 8.6 (4.4) ml/min/1.73m2. Mean (SD) MSC was 55 (23), PSC was 43 (21), and the number of symptoms was 15 (7) with a symptom severity of 88 (18). Overall, LMM showed that in the year preceding dialysis MCS decreased by 15.7 (95% CI: 11.9 to 19.5), PCS decreased by 12.0 (8.2 to 15.7), symptom number increased by 3.5 (2.5 to 4.6) and symptom severity increased by 5.3 (1.8 to 8.8). In the year following dialysis, MCS increased by 1.9 (-2.7 to 6.5), PCS decreased by 2.1 (-6.9 to 2.8), symptom number decreased by 0.9 (-0.3 to 2.1) and symptom severity decreased by 7.6 (2.8 to 12.4). Conclusion Both mental and physical HRQOL, as well as symptom number and severity, worsened considerably during the year preceding dialysis, but stabilized after dialysis initiation. These results could aid nephrologists in informing older ESKD patients who consider starting dialysis and improve the shared decision making process.

scholarly journals TRANS VESICAL PROSTATECTOMY

2010 ◽  
Vol 17 (04) ◽  
pp. 578-580
Author(s):  
NISAR AHMED ◽  
MASUD MALIK ◽  
ABDUL RASHEED ◽  
Malik Hussain ◽  
Muhammad Iqbal ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Erectile Dysfunction ◽  
Adverse Events ◽  
Symptom Severity ◽  
Retrograde Ejaculation ◽  
P Value ◽  
Life Questionnaire ◽  
Symptom Index ◽  
A Prospective Study

To determine the effectiveness of prostectomy in reducing symptom severity and quality of life. Design: A prospective study. Setting: Urology department civil hospital Dadu. Period: 2005 to 2007. Patients & methods: 100 men under going prostectomy were assessed using the American urological Association (AUA) symptom index score and quality of life. The adverse events like urinary incontinence, erectile dysfunction and retrograde ejaculation also detected. The outcome was assessed after 3 month of prostectomy. Results:Prostectomy was effective in reducing symptoms. Initial mean IPSS was 25 and reduced to 7 with p value < 0.001. Quality of life also assessed which showed majority of cases were mostly satisfied. Adverse events like transient incontinence 10%, retrograde ejaculation in 65% and erectile dysfunction in 25% respectively. Conclusion: Prostectomy is effective in reducing symptom severity and improve quality of life whichwas detected by IPSS and quality of life questionnaire.

510 A Profile of Physical Performance Variables in an Out-Patient Adult Population with Narcolepsy

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A201-A201
Author(s):  
Ragy Tadrous ◽  
Julie Broderick ◽  
Niamh Murphy ◽  
Lisa Slattery ◽  
Gillian Quinn ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Physical Performance ◽  
Symptom Severity ◽  
Health Related Quality ◽  
Cardiopulmonary Fitness ◽  
Performance Variables ◽  
Related Quality ◽  
Health Related

Abstract Introduction Narcolepsy can significantly impact the physical and mental wellbeing of people with narcolepsy, and has been associated with significant reductions in quality of life and physical performance. People with narcolepsy demonstrate many barriers to being physically fit and active, such as sleepiness and social isolation. Despite physical functioning and vitality being the most affected domains of health-related quality of life in this cohort, little is known about how physical performance variables are affected in people with narcolepsy. Methods This cross-sectional study profiled the physical performance of adults with narcolepsy attending the Narcolepsy Centre located in St. James’s Hospital. Participants underwent a physical performance test battery that investigated cardiopulmonary fitness, physical activity, muscle strength and endurance. Furthermore, health-related quality of life (HRQoL), symptom severity and sedentary behaviour was ascertained through self-report questionnaires. Results A total of 23 participants were recruited in this study. The majority of participants were female (n=13, 56.52%) and the mean age was 31.53 (± 13.17) years. Physical performance was generally found to be lower than age-and-gender matched normative values for cardiopulmonary fitness, physical activity and muscle strength and endurance. Participants’ completed 42.20 ± 21.41 minutes of moderate-vigorous physical activity daily as measured by actigraphy. Considerable sedentary behaviour was objectively measured in this sample (10.21 hours). Symptom severity was high as measured by the Epworth Sleepiness Scale and the Narcolepsy Severity Scale, and participants reported reduced quality of life when compared to general population norms (US, UK, France and Norway). Conclusion Markedly reduced physical performance was identified in this sample of people with narcolepsy, irrespective of participant age, gender and BMI. Future research should explore the role of exercise in improving the physical fitness in people with narcolepsy, and the influence of exercise on HRQoL and symptom severity in this cohort. Support (if any) This study was completed as part of Mr Ragy Tadrous’ Master of Science (MSc) degree in Trinity College Dublin. This degree was co-sponsored by the Physiotherapy Department in St. James’s Hospital, Dublin.

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