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Roux-en-Y gastric bypass as a salvage solution for severe and refractory gastroparesis in malnourished patients

  • David Moszkowicz
    Correspondence
    Correspondence: David Moszkowicz, M.D., Ph.D., Service de chirurgie viscérale digestive, Hôpital Louis-Mourier, 178 rue des Renouillers, 92700 Colombes, France.
    Affiliations
    Université de Paris, Gastrointestinal and Metabolic Dysfunctions in Nutritional Pathologies, Centre de Recherche sur l’Inflammation Paris Montmartre INSERM UMRS 1149, F-75890, Paris, France

    Service de chirurgie générale et digestive, AP-HP, Hôpital Louis Mourier, DMU ESPRIT-GHU AP-HP, Nord-Université de Paris, Colombes, France
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  • Germano Mariano
    Affiliations
    Service de chirurgie générale et digestive, AP-HP, Hôpital Louis Mourier, DMU ESPRIT-GHU AP-HP, Nord-Université de Paris, Colombes, France
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  • Heithem Soliman
    Affiliations
    Service d’hépato-gastro-entérologie, AP-HP, Hôpital Louis Mourier, DMU ESPRIT-GHU AP-HP, Nord-Université de Paris, Colombes, France
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  • Daniela Calabrese
    Affiliations
    Service de chirurgie générale et digestive, AP-HP, Hôpital Louis Mourier, DMU ESPRIT-GHU AP-HP, Nord-Université de Paris, Colombes, France
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  • Benoit Coffin
    Affiliations
    Université de Paris, Gastrointestinal and Metabolic Dysfunctions in Nutritional Pathologies, Centre de Recherche sur l’Inflammation Paris Montmartre INSERM UMRS 1149, F-75890, Paris, France

    Service d’hépato-gastro-entérologie, AP-HP, Hôpital Louis Mourier, DMU ESPRIT-GHU AP-HP, Nord-Université de Paris, Colombes, France
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  • Henri Duboc
    Affiliations
    Université de Paris, Gastrointestinal and Metabolic Dysfunctions in Nutritional Pathologies, Centre de Recherche sur l’Inflammation Paris Montmartre INSERM UMRS 1149, F-75890, Paris, France

    Service d’hépato-gastro-entérologie, AP-HP, Hôpital Louis Mourier, DMU ESPRIT-GHU AP-HP, Nord-Université de Paris, Colombes, France
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Published:January 31, 2022DOI:https://doi.org/10.1016/j.soard.2022.01.017

      Abstract

      Background

      Gastroparesis (GP) is a rare condition for which several symptomatic treatments are available, but they may fail, leading to a discussion of gastrectomy. Few studies have described gastric-preserving surgery, particularly in malnourished patients.

      Objective

      To describe the treatment of severe refractory GP with Roux-en-Y gastric bypass (RYGB).

      Setting

      A university center.

      Methods

      A retrospective review was conducted of adult patients who underwent laparoscopic RYGB. Severity and frequency of GP symptoms were compared before and 1 year after surgery using the Gastroparesis Cardinal Symptom Index (GCSI) score (0–5), the vomiting (VM) score (0–4), and the visual analog scale (VAS) for abdominal pain.

      Results

      Of the 9 patients with refractory GP, 7 were malnourished and 2 had obesity. There were no postoperative deaths. One patient was operated on for internal hernia without bowel necrosis. The mean GCSI score decreased significantly from 3.6 (range: 1–5) preoperatively to 2.1 (range: .3–4.4) postoperatively (P = .0019). The mean VM score improved significantly after surgery, from .22 (range: 0–1 units) preoperatively to 2.55 (range: 1–4) postoperatively (P = .007). The mean VAS score also decreased significantly from 7.0 (range: 5–9) preoperatively to 2.44 (range: 0–7) postoperatively (P = .0015). A nonsignificant weight and albumin change was observed at 1 year postoperatively, with a tendency for weight regain in malnourished patients.

      Conclusion

      In malnourished patients with severe and refractory GP, this study suggests the feasibility, safety, and efficacy of RYGB for the treatment of vomiting and abdominal pain.

      Keywords

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      Linked Article

      • Comment on: Roux-en-Y gastric bypass as a salvage solution for severe and refractory gastroparesis in malnourished patients
        Surgery for Obesity and Related DiseasesVol. 18Issue 5
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          In the current study, Moszkowicz et al. (2022) report their experience with Roux-en-Y gastric bypass (RYGB) in malnourished patients for the primary surgical indication of refractory gastroparesis [1]. Roux-en-Y for gastroparesis with or without gastrectomy has been in the surgical armamentarium for many years as a treatment for gastroparesis. Watkins et al. (2003) reported their experience with 7 patients undergoing gastrectomy with Roux-en-Y reconstruction with good immediate and long-term symptom resolution but high long-term morbidity in a at risk patient population with type 1 diabetes [2].
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