title: Gastric bypass surgery as treatment of recalcitrant gastroparesis.
abstract: BACKGROUND
  Few treatments for idiopathic and diabetic gastroparesis exist beyond symptom management, and no study has described gastric surgery for gastroparesis in obese and morbidly obese patients. The objective of this study was to describe treatment of recalcitrant gastroparesis in obese adults with Roux-en-Y gastric bypass (RYGB) surgery.
  
  
  METHODS
  A retrospective review was conducted of adult patients who underwent laparoscopic RYGB. Clinical data pre- and postsurgery and at a follow-up of up to 2 years were reviewed. Total symptom scores for gastroparetic symptom severity and frequency were compared presurgery and at follow-up using paired t tests.
  
  
  RESULTS
  Seven obese and morbidly obese patients (body mass index [BMI] = 39.5, range = 33-54; 6 women) with idiopathic or diabetic gastroparesis reported marked symptom improvement, and total symptom scores significantly decreased after RYGB. All 4 patients who were taking prokinetics preoperatively no longer required their medication after surgery. Three patients required prolonged treatment with antinausea medications in the postoperative period. Mean BMI change was 9.1 units and mean percent excess weight lost was 71.6 lbs. No perioperative complications were experienced. Two required readmissions due to various concerns (dysphagia, nausea, anastomotic ulcer).
  
  
  CONCLUSIONS
  In our cohort, no patients required the use of prokinetics after surgery and everyone experienced significant improvement in symptoms. Importantly, we found that RYGB is a safe surgical treatment for gastroparesis in obese patients. Our results indicate that gastroparesis, primarily believed to result in being underweight, can present in morbid obesity and can be markedly improved with RYGB.
authors.affiliation: Division of Metabolic and Bariatric Surgery, Hartford Hospital, Hartford, Connecticut. Electronic address: pavlos.papasavas@hhchealth.org.
authors.forename: Pavlos K
authors.initials: PK
authors.lastname: Papasavas
authors.affiliation: Division of Metabolic and Bariatric Surgery, Hartford Hospital, Hartford, Connecticut.
authors.forename: Janet S
authors.initials: JS
authors.lastname: Ng
authors.affiliation: Division of Metabolic and Bariatric Surgery, Hartford Hospital, Hartford, Connecticut.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Stone
authors.affiliation: University of Connecticut School of Medicine, Farmington, Connecticut.
authors.forename: Olayemi A
authors.initials: OA
authors.lastname: Ajayi
authors.affiliation: Integrated General Surgery Residency, University of Connecticut, Farmington, Connecticut.
authors.forename: Kiranmayi P
authors.initials: KP
authors.lastname: Muddasani
authors.affiliation: Division of Metabolic and Bariatric Surgery, Hartford Hospital, Hartford, Connecticut.
authors.forename: Darren S
authors.initials: DS
authors.lastname: Tishler
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002908:Chronic Disease; D048909:Diabetes Complications / Q000601:surgery*; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D018589:Gastroparesis / Q000150:complications / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009765:Obesity / Q000150:complications / Q000601:surgery*; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss
keywords: Gastroparesis; Roux-en-Y gastric bypass