Background and Aims: Gastroparesis is a symptomatic chronic disorder of the stomach characterized by delayed gastric emptying in the absence of mechanical obstruction. Several endoscopic treatment modalities have been described that aim to improve gastric emptying and/or symptoms associated with gastroparesis refractory to dietary and pharmacologic management. Methods: In this report we review devices and techniques for endoscopic treatment of gastroparesis, the evidence regarding their efficacy and safety, and the financial considerations for their use. Results: Endoscopic modalities for treatment of gastroparesis can be broadly categorized into pyloric, nonpyloric, and nutritional therapies. Pyloric therapies such as botulinum toxin injection, stent placement, pyloroplasty, and pyloromyotomy specifically focus on pylorospasm as a therapeutic target. These interventions aim to reduce the pressure gradient across the pyloric sphincter, with a resultant improvement in gastric emptying. Nonpyloric therapies, such as venting gastrostomy and gastric electrical stimulation, are intended to improve symptoms. Nutritional therapies, such as feeding tube placement, aim to provide nutritional support. Conclusions: Several endoscopic interventions have shown utility in improving the quality of life and symptoms of select patients with refractory gastroparesis. Methods to identify which patients are best suited for a specific treatment are not well established. Endoscopic pyloromyotomy is a relatively recent development that may prove to be the preferred pyloric-directed intervention, although additional and longer-term outcomes are needed.
Bibliographical noteFunding Information:
DISCLOSURE: The following authors disclosed financial relationships: P. Jirapinyo: Consultant for GI Dynamics and Endogastric Solutions; research support from GI Dynamics, Apollo Endosurgery, and Fractyl. B. Abu Dayyeh: Consultant for Metamodix, BFKW, DyaMx, and Boston Scientific; research support from Apollo Endosurgery, USGI, Spatz Medical, GI Dynamics, Cairn Diagnostics, Aspire Bariatrics, and Medtronic; speaker for Johnson and Johnson, Endogastric Solutions, and Olympus. M. Bhutani: Research support from Silenseed Inc, Galera Inc, Oncosil Inc, and Augmenix Inc; food, beverage, or travel compensation from Boston Scientific, Augmentix, and Conmed Corporation. V. Chandrasekhara: Advisory board for Interpace Diagnostics; shareholder in Nevakar, Inc. K. Krishnan: Consultant for Olympus Medical. N. Kumta: Consultant for Boston Scientific, Olympus Corporation of the Americas, Gyrus ACMI, Inc, and Apollo Endosurgery US Inc. D. Lichtenstein: Consultant for Allergan Inc, Augmenix, Gyrus ACMI, Inc, and Olympus Corporation of the Americas; speaker for Aries Pharmaceutical, Gyrus ACMI, Inc, and Olympus Corporation of the Americas; tuition compensation from Erbe USA Inc. J. Melson: Research support from Boston Scientific; stock options in Virgo Imaging. R. Pannala: Consultant for HCL Technologies; travel compensation from Boston Scientific; stockholder in AbbVie. G. Trikudanathan: Speaker and honorarium from Boston Scientific; advisory board for Abbvie. A. Trindade: Consultant for Olympus Corporation of the Americas and Pentax of America, Inc; food and beverage compensation from Boston Scientific; research support from NinePoint Medical, Inc. A. Sethi: Consultant for Olympus America, Boston Scientific, and Fujifilm. R. Watson: Consultant for Apollo Endosurgery, Boston Scientific, Medtronic, and Neptune Medical Inc; speaker for Apollo Endosurgery and Boston Scientific.
Dr. Parsi’s time to develop this manuscript was supported by The Louisiana Board of Regents Endowed Chair for Eminent Scholars and C. Thorpe Ray, MD endowed chair in Medicine.
© 2020 American Society for Gastrointestinal Endoscopy
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PubMed: MeSH publication types
- Journal Article
- Practice Guideline