Through-the-scope transpyloric stent placement improves symptoms and gastric emptying in patients with gastroparesis

Case 1

A 23-year-old woman was evaluated in clinic for diabetic gastroparesis. At the time of our evaluation, she was symptomatic despite a regimen consisting of domperidone, esomeprazole, ondansetron, duloxetine, and promethazine. Previous attempts using erythromycin and metoclopramide were both unsuccessful and limited by side effects. She continued to undergo frequent hospitalization, with four admissions to our facility plus numerous admissions to her local hospital. A 4-hour solid state gastric emptying scintigraphy study revealed only 47 % emptying at 4 hours. Gastric stimulation was declined by her insurance company and she therefore proceeded with transpyloric stent placement ([Fig. 1 a – c]).

Fig. 1 Placement of self-expandable metallic stent across the pyloric channel. a The delivery system is placed across the pylorus. b The stent is deployed under endoscopic guidance without fluoroscopy and with the aid of the yellow endoscopic marker at the proximal end of the stent. c The stent is fully deployed in the transpylori position with its proximal end in the gastric antrum.

The patient reported complete resolution of her daily morning nausea and cessation of all vomiting after stent placement. Her repeat 4-hour solid-state gastric scintigraphy, obtained 1 month after stent placement, was normal with 93 % emptying at 4 hours. Approximately 1 month after placement she developed recurrent symptoms in the context of stent migration that resolved after stent removal and replacement. She remains well 115 days after stent placement.