An endoscope can be used to inject Botox into the pylorus. With very early stage disease, this can relax the muscles of the pylorus allowing it to open and the stomach to empty. The effect is only temporary, so repeated injections are necessary.
As gastroparesis progresses, inflammation replaces the muscle with scar tissue called fibrosis. Once there is fibrosis, Botox is no longer effective. As the fibrosis gets thicker, the pylorus gets tighter. This creates progressive stomach blockage.
An endoscope can also be used to cut the muscle of the pylorus. This is called a pyloromyotomy. When done endoscopically, a pyloromyotomy is called G-POEM or POP. Many people, including doctors, think pyloromyotomy and pyloroplasty are the same, but they are not. Click here to check out our blog post that discusses this in much more detail.
Similar to Botox, pyloromyotomy may work for those that have not yet developed fibrosis. Pyloroplasty works regardless how fibrotic the pylorus has become. At Vanguard Surgical, we do not offer Botox injections or G-POEM/POP because patients typically have a fibrotic pylorus by the time they see a doctor.
Pyloroplasty is the most effective therapy and never needs to be repeated. While more invasive than the endoscopic procedures, it is an outpatient, home same day procedure. Having done nearly 2,000 laparoscopic pyloroplasty procedures, Dr. Hughes' rate of significant complications is <0.5%