Baxter Smith, Salwa Gautama, Julie Playfair, Kalai Shaw, Greg Snell, Glen Westall, Wendy Brown, Paul Burton
Gastroparesis is common among lung transplant recipients and is associated with poorer long-term lung allograft function. Pyloric botulinum toxin injection and balloon dilation are established treatments for the management of delayed gastric emptying and may play a role in the prevention of lung allograft dysfunction.
To determine the effect of therapeutic gastroscopy on lung function testing (LFT) in patients with gastroparesis post lung transplantation
Patients were retrospectively identified from the Alfred Hospital oesophago-gastric database who had undergone both lung transplantation and therapeutic gastroscopy between January 2012 and December 2017. Endoscopic treatment of gastroparesis was with pyloric botulinum toxin injection with or without pyloric balloon dilation. LFT and gastric emptying scintigraphy results pre and post gastroscopy were then compared.
Twenty-Seven patients (17 females) with a mean age of 56 years underwent a total of 31 therapeutic gastroscopies with LFT at 6 months prior, 6 months post, and 12 months post. The mean pre-intervention FEV1 and percent predicted FEV1 were 1.74L/min and 62.7% respectively. The mean time to therapeutic gastroscopy after transplant was 8.9 months (range 11 days to 9 years). Patients had an objective improvement in mean gastric emptying half-time after therapeutic gastroscopy (348 vs 140 minutes, P=0.0081). Patients had statistically significant improvements in mean FEV1 at 6 months post intervention (2.29L/min, P=0.013) with a maintained benefit at 12 months (2.28L/min P=0.022). There was also a significant improvement in % predicted FEV1 at 6 months (81.5%, P=0.0161) with sustained improvement to 12 months (82.5%, P=0.0162).
Therapeutic gastroscopy is associated with improved gastric emptying and long term sustained improvements in LFTs in patients with gastroparesis post lung transplantation.