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Gastroparesis

GastroparesisImageGastroparesis, also called delayed gastric emptying, is a disorder that slows or stops the movement of food from the stomach to the small intestine.  Normally, the muscles of the stomach, which are controlled by the vagus nerve, contract to break up food and move it through the gastrointestinal (GI) tract.  The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus.  The movement of muscles in the GI tract, along with the release of hormones and enzymes, allows for the digestion of food.  Gastroparesis can occur when the vagus nerve is damaged by illness or injury and the stomach muscles stop working normally.  Food then moves slowly from the stomach to the small intestine or stops moving altogether.  

The most common symptoms of Gastroparesis are nausea, a feeling of fullness after eating only a small amount of food, and vomiting undigested food—sometimes several hours after a meal.  This condition is thought to affect about 4% of the population.  Approximately 40% of patients have no definite cause for their condition even with medical testing.  About 33% of patients have a long history of diabetes.  The remaining patients have either a history of stomach surgery or another unusual medical condition. 

Traditionally, the management of Gastroparesis has relied on maintaining a high carbohydrate type of diet with small meals.  For patients with more severe disease, they have generally been treated surgically placing a feeding tube through the abdominal wall directly into a part of the small intestine called the jejunum.  The surgical procedure is known as a jejunostomy.  The feeding tube bypasses the stomach and delivers a special liquid food with nutrients directly into the jejunum. 

More recently, there has been an increasing role for the surgeon in the management of Gastroparesis beyond a jejunostomy.  Even though significant published data is lacking due to a low level of interest in this condition, there are several minimally invasive laparoscopic procedures available for patients experiencing Gastroparesis.

Laparoscopic pyloroplasty can be performed to widen the opening in the lower part of the stomach (pylorus) so that stomach contents can empty into the small intestine.  

Laparoscopic Gastric Stimulator “Enterra” is an option for normal weight diabetic patients with predominantly nausea and vomiting symptoms.  It is a surgically implanted battery-operated device, sends mild electrical pulses to the stomach muscles to help control nausea and vomiting.  It has been associated with about 80% improvement in these patients’ symptom scores.

Laparoscopic subtotal gastrectomy is the most aggressive and reliable option to manage all sub-groups of Gastroparesis.  This surgical procedure removes most of the stomach to enable patients to eat small amounts of food with minimal or no nausea resulting in 85-90% resolution of their symptoms.  Utilizing less invasive surgical techniques, this procedure is associated with much less risk than before and patients can typically leave the hospital within two days and be back to their normal lives within 1-2 weeks.

Laparoscopic Vertical Sleeve Gastrectomy is a new procedure that is being evaluated for patients with gastroparesis.  It is well established as a successful weight loss procedure and there is some early data to suggest that patients with gastroparesis can benefit from this surgical approach. 

Videos

Laparoscopic Gastric Stimulator

Laparoscopic Placement of a Gastrostomy Feeding tube

Laparoscopic Pyloroplasty

Laparoscopic Pyloroplasty for Delayed Gastric Emptying

Laparoscopic SubTotal Gastrectomy for Gastroparesis

Laparoscopic Sleeve Gastrectomy