Su1452 Analyses of Long-Term Follow-Up of Gastric Electrical Stimulation Therapy and Pyloroplasty for Refractory Gastroparesis

Abstract

G A A b st ra ct s amplitude of antral contractions Luminal obliteration Motility index Characterize antral contractility and identify its role in patients with rapid gastric emptying (RGE) and delayed gastric emptying (DGE). Describe antral contractility patterns in patients with UGIMD and normal gastric emptying (NGE) and role in explaining symptoms. METHODS Age, clinical presentation, gender, diabetes mellitus, other comorbidities, and ethnicity were documented in 10 patients who underwent GES and DAS from October to November of 2014. All patients ingested a standardized low-fat meal (255 kCal) labeled with 2 mCi of Tc-99m SC, obtaining 1-minute static images in the anterior and posterior projections at 30, 60, 120, 180 and 240 minutes. The DAS methodology involved 512 dynamic images at 0.5 second per frame acquired in the anterior projection at 15, 30, 45, 60, 90, 180 and 240 minutes. The data was analyzed to derive the following mean parameters of antral motility: a) Frequency, rhythm, coordination and amplitude of contractions, representing the cyclic variation of labeled meal, b) Obliteration or fraction of labeled meal that leaves the antrum during each contraction and c) Motility index or fraction of contents leaving the antrum per minute (product of obliteration and frequency). RESULTS The mean age was 53 years (21-67), 8 females, 3 had diabetes mellitus. Two patients with DGE (1 diabetic and 1 idiopathic) had the highest contraction frequency, but the lowest contraction amplitude, obliteration and motility index (Fig. 1). Two patients with RGE (1 diabetic and 1 idiopathic) had the lowest contraction frequency, but the highest amplitude, obliteration, and motility index. The remaining 6 patients (5 idiopathic and 1 diabetic) had normal GEwith contraction parameters values in between those of the DGE and RGE patients (Table 1). CONCLUSION 1) In patients with UGIMD and DGE, the antral contraction parameters as assessed by DAS are less than 1/2 the values of NGE patients; 2) RGE patients had nearly 3 times higher contraction parameters than DGE patients, specifically having longer and more coordinated forceful contractions resulting in powerful motility index and faster gastric emptying and 3) DAS data complements GES results offering important additional assessment of gastric motility characteristics and parameters that have direct application to patient care and treatment decisions. Table 1: Quantitative parameters of antral motility in patients with upper GI motility disorder