WHAT IS GASTROPARESIA?
Gastroparesis is an alteration that consists of a decrease in the movements of the stomach, so the process of crushing and subsequent exit from the stomach will be slow and ineffective and the food will pass from the stomach to the intestine will occur more slowly than normal.
WHAT DISCOMFORT DOES IT CAUSE?
– Feeling of being excessively full after meals that have not been very abundant; This sensation lasts until the next meal.
– Swelling of the belly or stomach after the main meals.
– Feeling of satiety without being able to finish a normal meal.
– Nausea and vomiting usually after eating; It is characteristic that vomiting occurs several hours after meals and that food eaten in previous meals can be recognized.
– Progressive weight loss.
WHY DOES IT OCCUR?
It appears when there is a deterioration of the muscles that form the walls of the stomach and/or the nerves that regulate its functioning. In many, the cause of this lesion is unknown (idiopathic gastroparesis). Other times it can be secondary to diseases that can affect the muscles and nerves of the digestive tract, such as:
– Diabetes mellitus: it is the most common cause of gastroparesis; It is usually a diabetes that appears in youth, has a long evolution and is difficult to control and with other complications such as kidney, eye, etc.
– Post-surgical: after some interventions on the stomach such as when the nerves are cut (vagotomy) or when a part is removed (partial gastrectomy), or interventions on the esophagus or lungs in which, accidentally, the nerves are injured. vagus nerves that regulate the functioning of the stomach.
– Systemic diseases such as scleroderma, dermatomyositis and lupus erythematosus.
– When there is a general disorder of the movements of the digestive tract (chronic intestinal pseudo-obstruction).
How is it treated?
Until very recently there were no techniques with good results for this problem. Diets and medications only temporarily relieve symptoms.
The gastric pacemaker has irregular results and is rarely used, and BOTOX only offers improvement for 6 months. After this, the symptoms reappear again.
Surgical treatment requires removing a large part of the stomach, if not all, and part of the intestine, which is aggressive.
Gastric POEM.
It consists of performing an endoscopic section of the pyloric sphincter, the muscle located at the junction between the stomach and the small intestine, which reduces the resistance to the exit of food, and although the propulsive force of the stomach is not modified if We make it empty more easily since it does not have to overcome the resistance of the pyloric muscle.
It is one of the new minimally aggressive tunneling and endoscopic surgery techniques. The advantage of this technique is that it produces improvement in symptoms in many patients, and until now there was nothing that had acceptable results with low complication rates.
It is performed in the operating room and under orotracheal intubation and lasts approximately 90 minutes, with expected discharge in less than 48 hours. In the Unit, the gastric-POEM technique is performed, which is the best treatment to offer to patients with gastroparesis and which is currently available in very few National centers and none in the private sector.
The gastric POEM consists of making a small incision in the gastric mucosa, about 2 centimeters, to subsequently create a tunnel in the submucosa between the mucosa and muscular layers of the stomach. Later the tunnel extends until it reaches the pylorus. At this time, the myotomy, or cut of the pyloric muscle, is performed, leaving the mucosa intact, which will later cover this cut. The technique ends by suturing the entry hole to the mucosa with staples.
