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DOI: 10.1055/a-1076-0652
Full-thickness gastric plication with Overstitch endoscopic suturing device for postsurgical chronic gastroparesis
Corresponding author
Publication History
Publication Date:
22 January 2020 (online)
A 28-year-old woman with a past history of dysplastic Barrett’s esophagus treated with Ivor Lewis esophagectomy presented with recurrent episodes of dysphagia. Upper gastrointestinal (UGI) series showed delayed gastric emptying with pyloric hypertrophy secondary to postsurgical denervation of the vagal nerve trunks. After multiple unsuccessful endoscopic dilations of the pylorus, the patient underwent a Roux-en-Y gastrojejunostomy with antrum and pylorus exclusion, with resolution of symptoms ([Fig. 1 a]).
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After 2 years, she developed recurrent postprandial vomiting that did not respond to medical treatment, with consequent progressive weight loss. UGI series showed marked paresis and atony of the remnant conduit stomach, with prolonged transit time and severe stagnation ([Fig. 1 b], [Fig. 2]).
![](https://www.thieme-connect.de/media/endoscopy/202007/thumbnails/10-1055-a-1076-0652-i1360ev2.jpg)
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To avoid total gastrectomy, the definitive approach in cases of refractory gastroparesis, and considering the possible high peri- or postoperative complications [1], we opted for a full-thickness gastric plication using the OverStitch endoscopic suturing system (Apollo Endosurgery, USA) ([Video 1]). Under general anesthesia, we first dissected the mucosal layers of the borders of the atonic gastric area using an O-type HybridKnife (Erbe Electromedizin). Approximating the gastric walls, we excluded the major part of the remnant stomach, markedly reducing the receptive capacity, projecting the liquid/solid nutrients directly to the gastrojejunostomy more rapidly ([Fig. 1 c]).
Video 1 Postsurgical chronic gastroparesis successfully treated with a novel mini-invasive approach: full-thickness gastric plication using the Overstitch endoscopic suturing system. Source for graphical illustration: Federico Amata.
Quality:
Over the following 9 months, we observed resolution of symptoms and improvement in the kinetics of gastric emptying ([Fig. 3]).
![](https://www.thieme-connect.de/media/endoscopy/202007/thumbnails/10-1055-a-1076-0652-i1360ev3.jpg)
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Chronic gastroparesis is a motility dysfunction consisting of delayed gastric emptying that occurs in the absence of any identifiable outflow obstruction and does not respond effectively to traditional treatment [2] [3]. Chronic gastroparesis as a postsurgical complication is rare compared to the diabetes mellitus and idiopathic etiologies, but it can occur in cases of gastric resection and/or vagotomy [3] [4]. The mini-invasive endoscopic approach described here seems to be a valid alternative, particularly in patients with a history of multiple surgical revisions.
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Competing interests
The authors declare that they have no conflict of interest.
Acknowledgments
We thank Federico Amata for graphics assistance.
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References
- 1 Landreneau JP, Strong AT, El-Hayek K. et al. Gastrectomy versus stomach left in situ with Roux-en-Y reconstruction for the treatment of gastroparesis. Surg Endosc 2019; DOI: 10.1007/s00464-019-06951-3.
- 2 Abrahamsson H. Treatment options for patients with severe gastroparesis. Gut 2007; 56: 877-883
- 3 Waseem S, Moshiree B, Draganov PV. Gastroparesis: current diagnostic challenges and management considerations. World J Gastroenterol 2009; 15: 25-37
- 4 Samuel B, Atiemo K, Cohen P. et al. The effect of sleeve gastrectomy on gastroparesis: short clinical review. Bariatr Surg Pract Patient Care 2016; 11: 84-89
Corresponding author
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References
- 1 Landreneau JP, Strong AT, El-Hayek K. et al. Gastrectomy versus stomach left in situ with Roux-en-Y reconstruction for the treatment of gastroparesis. Surg Endosc 2019; DOI: 10.1007/s00464-019-06951-3.
- 2 Abrahamsson H. Treatment options for patients with severe gastroparesis. Gut 2007; 56: 877-883
- 3 Waseem S, Moshiree B, Draganov PV. Gastroparesis: current diagnostic challenges and management considerations. World J Gastroenterol 2009; 15: 25-37
- 4 Samuel B, Atiemo K, Cohen P. et al. The effect of sleeve gastrectomy on gastroparesis: short clinical review. Bariatr Surg Pract Patient Care 2016; 11: 84-89
![](https://www.thieme-connect.de/media/endoscopy/202007/thumbnails/10-1055-a-1076-0652-i1360ev1.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
![](https://www.thieme-connect.de/media/endoscopy/202007/thumbnails/10-1055-a-1076-0652-i1360ev2.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
![](https://www.thieme-connect.de/media/endoscopy/202007/thumbnails/10-1055-a-1076-0652-i1360ev3.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)