Gastroparesis is a poorly understood disease that affects 4% of the population. Unfortunately, there is currently no cure for gastroparesis. Treatment relies on several pro-motility and anti-nausea medications. Medical treatment fails to address the underlying dysmotility problem and is therefore quite ineffective. Gastroparesis patients have limited options and are left most of the time in hopeless situations fighting a disease that affects every single aspect of their daily life. Living with gastroparesis is hard. Coping with symptoms like bloating, pain, nausea, vomiting and inability to tolerate regular food is a daunting task to the strongest of us.

I have had the chance over the past few years to develop a surgical procedure that promotes gastric emptying. The idea behind the procedure is based on several published reports demonstrating increased gastric emptying following sleeve gastrectomy. The exact mechanism of action of increased gastric emptying following gastric sleeve surgery is not well understood. It is partly due to decreased gastric wall compliance. Gastric emptying however, is a highly coordinated process. Several neuro-hormonal signals generated by the stomach and duodenum in response to food intake coordinate stomach emptying. Sleeve gastrectomy alters some of these signals leading to accelerated gastric emptying. Weight loss appears to be a side effect of this altered motility.

For gastroparesis patients, I performed an antrum preserving longitudinal gastrectomy. Around 75% of the gastric fundus and body are resected. The antrum which is the stomach pump is completely preserved. Most gastroparesis patients have a dilated gastric fundus and body and a normal size antrum. The antrum is a thick muscular compartment and is a main contributor to the Magenstrasse gastric emptying. I believe that gastroparesis patients have abnormal Magenstrasse emptying. The modified sleeve gastrectomy I perform restores the Magenstrasse and contributes to improvements in gastric emptying.

All my gastroparesis patients who underwent the modified sleeve gastrectomy have had complete resolution of their symptoms. Some of these patients agreed to undergo a post-operative gastric emptying study that showed normal gastric emptying rate. I operated on 2 obese patients with gastroparesis and advanced type 2 diabetes. I offered these patients a traditional sleeve gastrectomy. I perform an antrum preserving sleeve gastrectomy on all my patients. Preserving the antrum promotes gastric emptying and is associated with excellent weight loss and diabetes improvement. Both patients had complete resolution of their gastroparesis related symptoms. Their post-operative contrast studies demonstrated accelerated contrast emptying from the stomach.

Do we have a cure for gastroparesis? In my limited series of patients, the answer is YES. I think that restoring the Magesntrasse by preserving the antrum, resecting the greater curvature of the gastric body and most of the gastric fundus is an effective, safe, and durable treatment for gastroparesis. A prospective randomized study is needed to establish this approach to help millions of suffering gastroparesis patients all over the world.