Gastroparesis is characterized by delayed gastric emptying in the absence of obstruction. Common symptoms include
nausea,
vomiting, and
abdominal pain. Severe
gastroparesis might result in recurrent hospitalizations,
malnutrition, and significant mortality. Patients failing medical
therapy are often considered for a variety of surgical interventions, the efficacy of which is not well studied. This review summarizes available literature on surgical interventions in
gastroparesis. A MEDLINE search for the period from 1966 to 2002 was performed to identify all English language literature regarding surgical interventions in
gastroparesis.
Therapies reviewed were
gastrostomy,
jejunostomy, gastric pacing/stimulation, and
gastrectomy or surgical drainage procedures. Candidate studies involved human subjects and included surgical series or trials. The search was conducted independently by two authors and discrepancies resolved by consensus opinion. Seventeen articles met inclusion criteria. These included series reporting on
gastrostomy (2),
jejunostomy (3), gastric stimulation (2), and
gastrectomy for postsurgical (6), diabetic (3), and idiopathic (1)
gastroparesis. All trials were unblinded, uncontrolled case series or retrospective reviews. Methodologic differences did not allow for pooled analysis. Completion
gastrectomy seems to provide symptom relief in postsurgical
gastroparesis. Benefits of gastric surgery for other forms of
gastroparesis are not adequately studied.
Gastrostomy might provide symptom improvement, but only 26 subjects in two trials were evaluable.
Jejunostomy improved symptoms and nutrition in 32 evaluable subjects in three trials but had significant complications. Gastric neurostimulation improves symptoms of
nausea and
vomiting, but therapeutic gain beyond placebo has not been demonstrated. Limited data exist concerning surgical
therapies of
gastroparesis. Completion
gastrectomy seems effective for postsurgical
gastroparesis, but a cautious approach is warranted before surgical
therapies in diabetic or idiopathic
gastroparesis are used.