XXXX in patients undergoing antireflux surgery: analysis of a treatment algorithm.

@entity1 @entity7623 @entity5274 @entity356
PURPOSE: Controversy remains about the treatment of @entity1 with mild @entity356 (90 min < emptying half-time [T(1/2)] < 180 min) who undergo antireflux surgery. This retrospective, nonrandomized study reviewed the records of @entity1 treated from January 1996 through October 2003, during which time we applied two treatment algorithms for @entity1 with mild @entity356 . The goal of this study was to determine whether the most recent treatment algorithm was effective in reducing the need for a concomitant gastric drainage procedure, pyloroplasty. MATERIALS AND METHODS: Eighteen @entity1 with mild @entity356 underwent antireflux surgery plus pyloroplasty (group A) before 2001, and 13 @entity1 with mild @entity356 underwent antireflux surgery plus gastric decompression with percutaneous endoscopic gastrostomy placement (group B) starting in 2001. We reviewed indications for the procedure, complications, and outcomes. Primary outcome measures for this study were recurrence of @entity7623 symptoms and need for pyloroplasty. RESULTS: The average T(1/2) was similar for both groups A and B: 129 min and 123 min, respectively. Eleven of 13 @entity1 (85%) in group B experienced resolution of @entity7623 symptoms, improved gastric emptying times, or both; only 1 @entity1 (8%) underwent subsequent pyloroplasty for treatment failure. Only one serious percutaneous endoscopic gastrostomy-related event occurred (tube migration), and no @entity1 died. Significantly fewer @entity1 in group B required total pyloroplasty (8% vs. 56% in group A; P < 0.008), and significantly fewer required pyloroplasty for symptomatic control (15% vs. 56% in group A; P < 0.03). CONCLUSION: A treatment algorithm incorporating percutaneous @entity5274 placement at the time of antireflux surgery for gastric decompression successfully managed antireflux surgery @entity1 with mild @entity356 . This approach allows for a more selective use of pyloroplasty.
