P0392 - Do Histological Characteristics of the Gastric Smooth Muscle Predict Clinical Outcomes in Gastroparetic Patients After Surgical Pyloroplasty?

Irene Sarosiek, MD¹, Brian Davis, MD¹, Karina Espino, MS², Jesus Diaz, MD, DABR¹, Alok K. Dwivedi, PhD¹, Luis Alvarado, MS³, Osvaldo Padilla, MD, MPH¹, Richard McCallum, MD^1
1Texas Tech University Health Sciences Center at El Paso, El Paso, TX; ²Texas Tech University Health Sciences Center, El Paso, TX; ³Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, TX

Introduction: Pyloroplasty (PP) is recognized as a treatment option for severe gastroparetic (GP) patients. Assessment of the clinical and objective outcomes of PP is very limited. Therefore we aimed to investigate in gastroparetic patients undergoing surgical Heineken - Mikulicz pyloroplasty, if the changes in gastric emptying (GE) influence GP symptoms control, and whether the interstitial cells of Cajal (ICC) correlate with these changes in gastric emptying.

Methods: Surgically obtained full thickness antral and pyloric biopsies were collected during PP in 13 GP patients (6F; 12 diabetics and 1 idiopathic); mean age: 45 years (25-67); who had failed all available medical therapies. Mean duration of DM was 14 years (9-25). Mean duration of GP symptoms was 4.8 years (2-18). Tissues were stained with c-kit for the presence of ICC. Significant ICC depletion was defined as < 10 cells/HPF. All patients had the GP symptoms assessed by using the PAGI-SYM instrument, and a scintigraphic 4 hour gastric emptying (GE) test was done, at baseline and 3 months after surgery. The retention at 4 hrs of >10% of the study meal was defined as delayed gastric emptying.

Results: The 13 GP patients were divided into 2 groups based on the results of their follow up GE test at 3 months:

1) Patients (46%) who normalized their GE (NGE); gastric retention at 2 hrs was reduced from 64% to 30% (normal is < 60%), and 4 hrs retention decreased from 37% to 6% (normal is< 10%).

2) Patients (54%) who were still delayed with their gastric emptying (DGE) with a mean retention at 2 hrs reduced from 65% to 57%, and at 4hrs from 49% to 40%.

The average number of antral ICC in NGE patients was 13 (4-25)/ HPF and 11 (4-16) HPF in DGE group. Interestingly, the number of pyloric ICC was significantly depleted in NGE group with the mean 6.7 ICC/HPF (3-11), compared to the DGE group had 10 ICC/HPF (2-19) (p< 0.005)

Severity of GP symptoms improved significantly in both groups: NGE group reduced the score from 67 to 29 points by PAGI-SYM scale, and DGE score went from 68 to 37 points (p< 0.05) at 3 month follow up visit.

Discussion: <

< !1. Pyloroplasty normalizes gastric emptying in approx. 50% of severe gastroparetic patients.

< 2. Gastric emptying can normalize after PP despite ongoing depletion of ICC in antral smooth muscle.

< 3. The status of antral ICC doesn’t determine which patients normalize gastric emptying after surgical pyloroplasty.

< !4. Symptom improvement can be achieved regardless of normalizing gastric emptying.


Disclosures:


Irene Sarosiek, MD¹, Brian Davis, MD¹, Karina Espino, MS², Jesus Diaz, MD, DABR¹, Alok K. Dwivedi, PhD¹, Luis Alvarado, MS³, Osvaldo Padilla, MD, MPH¹, Richard McCallum, MD¹. P0392 - Do Histological Characteristics of the Gastric Smooth Muscle Predict Clinical Outcomes in Gastroparetic Patients After Surgical Pyloroplasty?, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.