Resolution of Post-Operative Delayed Gastric Emptying (DGE) with Acupuncture

Michael M. Rothkopf, MD, FACNLisa Haverstick RD, Eleni Pellazgu, APN

Atlantic Health SystemMetabolic Medicine Center

Morristown, NJ

National Board of Physician Nutrition Specialists

Post-operative Gastroparesis,Gastric stasis, and DGE

• After any upper gastrointestinal tract surgery

• Gastric surgery with vagotomy• Esophageal resections• ~60% of pancreatic surgery pts• Mechanisms poorly understood• Hypothesis - duodenal resection,

decreased plasma motilin levels, disruption of vagal and sympathetic innervation, relative devascularization/denervation of pylorus, anastomotic disruptions, transient pancreatitis

Wente MN, et al. Surgery 2007;142:761-8

Post-Operative DGE Options• Prokinetic agents

(erythromycin, metoclopramide, domperidone)

• Anti-emetic agents• Anti-spasmotic agents• Anti-narcotic agents• Pyloric botulinum toxin• Gastrostomy drainage tube • Jejunostomy feeding tube• TPN• Gastric pacemaker

Case Report – RK 68 year old male• Malignant pancreatic neoplasm• Successful resected, Whipple procedure performed 10-2-15• Persistent nausea and vomiting, postoperative abscess drained• NGT output >500 ml/shift after 2 weeks• TPN initiated• No significant findings on second look surgery, drainage PEG placed • No response to pro-motility agents• POD 89 –home on TPN, gastrostomy drainage• Gastric fluid output of ~2,000 ml/d persisted • POD 92, manual acupuncture at ST-36 performed x1• POD 93, gastrostomy drainage <100; BM • POD 94 began a liquid diet• Over several weeks, stomach capacity returned to normal, and he eventually

returned to a regular diet consistency and volume • Post-discharge day 30 - weight and nutritional parameters remained stable; weaned

off TPN 3-17-16 (POD 167), PEG removed

Acupuncture for DGE after Whipple?

• Rapid benefit of this patient’s DGE• Traditional method failure• Patient considered TPN and drainage tube dependent • Gastrostomy drainage reduced after one day• Bowel motility recovered after one day• PO intake began after 2 days• Patient weaned from TPN and gastrostomy removed• Last seen on 10-3-16, eating normally, weight stable

labs normal

How does Acupuncture Work on the Gastrointestinal System?

• Acupuncture has been used to treat emesis, PUD, dyspepsia, esophageal disease, pancreatic diseases, IBD, IBS, dysmotility, constipation, and diarrhea

• 300 + GI acupuncture points• In animal studies, acupuncture has been

shown to enhance GI pacemaker activity, vagal stimulation, efferent parasympathetics, serotonergic pathways, opiodonergic pathways, spinal or supraspinal reflexes, NMDA receptors and hypothalamic oxytocin

• fMRI studies suggest that acupuncture can effect the brain-gut axis (CNS, autonomic nervous system, hypothalamic-pituitary axis and brain-gut peptides)

Li H, er al. Acupuncture and regulation of gastrointestinal function. World J Gastroenterol 2015; 21(27): 8304-8313

Conclusion

• Acupuncture of the stomach meridian may be an important modality for patients with post-operative DGE

• This case demonstrates the benefits of considering integrative approach in treatment of GI conditions.

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