Efficacy and safety of endoscopic pyloric balloon dilation in patients with refractory gastroparesis.

Abstract

There has been interest in the use of pyloric therapies for the treatment of refractory gastroparesis. However, data on endoscopic pyloric dilation are scarce. We aimed to assess the efficacy and safety of this procedure in refractory gastroparesis. We performed a retrospective analysis of 47 patients referred for refractory gastroparesis, confirmed by gastric emptying scintigraphy, and treated with endoscopic pyloric through-the-scope balloon dilation. The primary endpoint was the effectiveness of the procedure, evaluated with the Gastric Cardinal Symptom Index (GCSI) at 2 and 6months. A clinical response, defined by a 1.0 point decrease in the GCSI score, was observed in 25 patients at 2months (53%) and in 19 patients at 6months (40%). The mean GCSI score decreased significantly at 2 and 6months compared to the preoperative score (3.9 ± 0.87 vs 2.3 ± 1.37 and 3.9 ± 0.87 vs 2.9 ± 1.27, respectively; p < 0.0001). No complication was observed. Nine patients had a delayed relapse at 1year. A second dilation was performed for eight patients and it was effective in five of them (63%). The mean follow-up time of the patients was 27.0 ± 10.4months. At 2years, 15 patients still experienced improvement following this treatment (32%). No predictive factor of clinical response was identified. The efficacy of pyloric dilation is 53% at 2months, with sustained improvement in one third of patients at 2years. This treatment should be considered as an alternative option to pyloromyotomy.