Elsevier

Gastrointestinal Endoscopy

Volume 78, Issue 5, November 2013, Pages 764-768
Gastrointestinal Endoscopy

Thinking outside the box
Gastric peroral endoscopic myotomy for refractory gastroparesis: first human endoscopic pyloromyotomy (with video)

https://doi.org/10.1016/j.gie.2013.07.019Get rights and content

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Methods and results

A 27-year-old woman was evaluated in clinic for diabetic gastroparesis. She had a history of insulin-dependent diabetes mellitus diagnosed at age 17. She had daily symptoms of nausea and vomiting and had multiple admissions for refractory symptoms and dehydration. At the time of our evaluation, she was symptomatic despite a regimen consisting of domperidone, esomeprazole, ondansetron, and promethazine. Previous attempts with erythromycin and metoclopramide were both unsuccessful and were

Discussion

Gastroparesis remains one of the most challenging conditions seen in gastroenterology practice today. Treatment options are limited, and for patients experiencing exacerbations there is little data to suggest that any specific therapeutic interventions can reliably change the course of the disease. Gastroparesis is a heterogeneous disorder with multiple subtypes and numerous hypothesized mechanisms involved in symptom pathogenesis. This is likely the reason data with regard to pyloric

Disclosure

M. Khashab is a consultant for Boston Scientific and Olympus America and has received research support from Cook Medical. J. Clarke is a consultant for ProStrakan and Wyeth. A. Kalloo and P. Pasricha are founding members, equity holders, and consultants for Apollo Endosurgery. No other financial relationships relevant to this publication were disclosed.

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