The pyloric revolution: Patient selection

Abstract Gastroparesis is a heterogeneous disorder with multiple clinically-relevant subsets. Some affected patients may have pyloric dysfunction as a primary etiology or contributor to their symptoms. Recognition of pyloric dysfunction is important as unique non-pharmacologic treatment options may be available; however, these pyloric-directed interventions are not without risk and it is important to identify those patients most likely to benefit. This chapter reviews our current understanding of pyloric dysfunction as it relates to gastroparesis as well as the available diagnostic methods to evaluate pyloric physiology, including antroduodenal manometry, the Functional Lumen Imaging Probe, and electrogastrography. In addition, we review available data regarding treatment options including botulinum toxin, pyloric stent placement, pyloroplasty and gastric per-oral endoscopic myotomy. We will also emphasize the limitations in our knowledge at present, and make suggestions as to how these gaps should be addressed in the future as well as critique the data currently available.