Gastroparesis occurs in about 5% to 24% of patients with gastric cancer after surgery. The first of these is a series of symptoms such as nausea, vomiting, and upper abdominal fullness, which can be understood as “gastric paralysis” after excluding the obstruction of the stomach and related tissues and organs caused by the lesion. The first of these is to make sure that the patient has a good understanding of the situation.
Why does gastroparesis occur?
The occurrence of gastroparesis may be related to the following factors:
- Preoperative underlying conditions, such as anemia, low protein, diabetes, and poor nutritional status, predispose patients with these conditions to develop gastroparesis postoperatively.
- Extensive lymph node dissection during radical gastric cancer surgery can destroy the nerves of the stomach, resulting in loss of nerve regulation in the remnant stomach and reduced mobility of the stomach wall.
- Postoperative secretion of gastrin, gastrin, and other hormones that promote gastric motility is reduced, making the stomach less motile, and at the same time, secretion of hormones that inhibit gastric emptying is increased.
- The manner in which the gastrointestinal tract is reconstructed can also have an impact on gastric emptying. For example, in patients who have undergone a Bi II-style GI reconstruction (i.e., the stomach is anastomosed to the jejunum), digestive juices such as bile can enter the remnant stomach through the anastomosis, which can lead to anastomotic edema and increase the incidence of gastroparesis.
- Severing some of the blood vessels around the stomach during surgery can reduce the blood and oxygen supply to the remnant stomach, and the stomach receives less energy, affecting its motor function.
- The trauma caused by the surgery itself may inhibit the contraction of the stomach and impair gastric motility.
How to avoid gastroparesis?
Before surgery, the surgeon will try to improve the patient’s nutritional level and control blood sugar and correct conditions such as low protein.
During surgery, care is also taken to reduce unnecessary injury and to minimize the amount of analgesic medication while ensuring that the patient is pain-free.
How is gastroparesis managed?
- Medication Almost all patients who develop gastroparesis require medications that promote gastrointestinal motility. Commonly used drugs include metoclopramide (gastrofluan), erythromycin, cisapride, domperidone, etc. The main function is to increase gastric contraction and promote intestinal motility and gastric emptying.
- Acupuncture Gastroparesis mostly occurs during hospitalization, and some patients can try acupuncture treatment to promote intestinal peristalsis by stimulating acupuncture points.
- Surgical treatment Gastroparesis is less often treated with surgery. In some patients who have difficulty recovering from gastroparesis, carrying a gastric tube for a long time can affect their quality of life, and doctors may consider surgery. Surgery may be an option to perform a gastrostomy combined with a jejunostomy. Patients who cannot tolerate eating through the mouth may have their contents drained by decompression through a gastrostomy tube, with a jejunostomy as an adjunct to eating. A very small number of patients also require total gastrectomy, which can be beneficial in the long term.
- Gastric electrical pacing A pacemaker is placed in the gastric wall to restore gastric motility by electrical stimulation. However, it is less commonly used. (Contributed by Chao Han, Department of Gastrointestinal Oncology, The First Hospital of China Medical University)