Medical and surgical management of gastroparesis: a systematic review

Abstract

Background: Gastroparesis (GPS) is a rare disease with multiple etiologies that results in delayed gastric emptying. Diagnosis of GPS can be challenging due to its rather complex clinical presentation. Pharmacologic refractory cases require surgical interventions, all of which have yet to be standardized and characterized.

Objectives: We present a review of the literature and provide an update of current therapies for patients with GPS.

Setting: Department of General Surgery, Academic Hospital, United States.

Methods: We conducted a comprehensive search in PubMed, Google Scholar, and Embase of English-written articles published in the last 38 years, with an advance title search of "gastroparesis management." Other keywords included: "surgical management" and "refractory gastroparesis." Further references were obtained through cross-reference.

Results: A total of 12,250 articles were selected after eliminating duplicates. Following thorough screening of selection criteria, 68 full-text articles were included for review.

Conclusion: GPS is a challenging disease to manage. Nutritional support must remain the primary approach, followed by either medical or surgical treatment modalities if necessary. In patients with refractory gastroparesis, adjunctive therapies have been proposed as promising long-term options.

Keywords: Gastric stimulator device; Gastroparesis; Per-oral pyloromyotomy; Pyloroplasty; Roux-en-Y gastric bypass.