Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2025
Suspected bile acid gastritis and dumping syndrome after pyloric drainage procedures: experience from a tertiary care center.
СтатьяНазвание и аннотация: Перевод в очереди
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Shargo Ryan, Poonen-Honig Isaac, Konidala Chamanthi, Dabbs Cameron, Peddi Pavani, Thélin Camille, DuCoin Christopher, Docimo Salvatore, Klam Rebecca, Dimou Francesca, Sujka Joseph
Аннотация
BACKGROUND: Pyloric drainage procedures, such as gastric peroral endoscopic myotomy (G-POEM) and pyloroplasty, have emerged as effective treatment modalities for refractory gastroparesis. Bile acid gastritis (BAG) and dumping syndrome (DS) are known complications of pyloric procedures. However, the incidence of these complications is underreported.
METHODS: A retrospective review of patients with refractory gastroparesis who underwent G-POEM or pyloroplasty (July 2019 to June 2024) was conducted. Data included demographics, gastroparesis etiology, preoperative reflux, procedure type, and postoperative interventions. The outcomes assessed were the incidence, timing of diagnosis, and treatment response for suspected BAG and DS. Statistical analyses were performed using the Pearson chi-square or Fisher exact tests for categorical variables and the Mann-Whitney U test for continuous variables.
RESULTS: Among 173 patients (the median age was 55 years, and 76.9% of patients were female), suspected BAG occurred in 16 patients (9.25%), with 9 cases confirmed both clinically and endoscopically. Of 15 patients with suspected BAG treated with cholestyramine, 5 reported symptom improvement. BAG was significantly associated with previous pyloroplasty (P =.003) and preoperative reflux (P =.044) but not with gastroparesis etiology (P =.125). DS was clinically suspected in 3 patients (1.73%) after the procedure. Dietary counseling improved symptoms in all cases.
CONCLUSION: The incidence rates of suspected BAG and DS were 9.25% and 1.73%, respectively. Pyloroplasty was more likely to result in symptoms suggestive of BAG than G-POEM. Further research is warranted to evaluate the accuracy of BAG and DS clinical diagnoses, the true incidence rates of these adverse events, and long-term outcomes in these patients.
METHODS: A retrospective review of patients with refractory gastroparesis who underwent G-POEM or pyloroplasty (July 2019 to June 2024) was conducted. Data included demographics, gastroparesis etiology, preoperative reflux, procedure type, and postoperative interventions. The outcomes assessed were the incidence, timing of diagnosis, and treatment response for suspected BAG and DS. Statistical analyses were performed using the Pearson chi-square or Fisher exact tests for categorical variables and the Mann-Whitney U test for continuous variables.
RESULTS: Among 173 patients (the median age was 55 years, and 76.9% of patients were female), suspected BAG occurred in 16 patients (9.25%), with 9 cases confirmed both clinically and endoscopically. Of 15 patients with suspected BAG treated with cholestyramine, 5 reported symptom improvement. BAG was significantly associated with previous pyloroplasty (P =.003) and preoperative reflux (P =.044) but not with gastroparesis etiology (P =.125). DS was clinically suspected in 3 patients (1.73%) after the procedure. Dietary counseling improved symptoms in all cases.
CONCLUSION: The incidence rates of suspected BAG and DS were 9.25% and 1.73%, respectively. Pyloroplasty was more likely to result in symptoms suggestive of BAG than G-POEM. Further research is warranted to evaluate the accuracy of BAG and DS clinical diagnoses, the true incidence rates of these adverse events, and long-term outcomes in these patients.