AM. Gupta, et al. Neurogastroenterology & Motility 2026. 38: e70436. Systematic Review: Role of Pyloric Dilation in the Management of Gastroparesis

Background: Gastroparesis is a difficult condition to treat and medical options are limited.

Study population: In total, 577 patients with gastroparesis (GP) who underwent pyloric dilatation (PyD) were studied with age range from 2 years to 51 years. 5 of the 12 selected studies enrolled children.

Methods: Various pyloric dilators (PyD) were used: hydraulic dilation with controlled radial expansion (CRE) balloon was most common [5] followed by pneumatic [3], and EsoFLIP [1]. In children, the size of CRE balloon was based on age or weight, but the cutoffs employed were variable. In adults, the CRE balloon diameter most often used was 20 mm.

Key findings:

• Quality of studies was fair to poor.
• Symptom improvement with PyD was described in 37%–85% of treated patients. PyD plus botulin toxin efficacy was reported as 50%–80%.
• Benefits were reported as early as 2 weeks and up to 2 years after intervention.
• None of the studies reported complications with PyD. One study reported transient post procedural pain in 60% of patients after PyD for a median of 1 day.

Discussion points:

• “Santucci et al. [24] is the only study with a placebo-controlled arm in this review, underscoring the need for more rigorous trials to decide on PyD’s role (with or without botox) in GP.” In this pediatric study, 76% of cases showed partial or complete improvement compared with 49% controls within 12 months (P = 0.004). Younger children tended to respond more favorably to the procedure (P = 0.08).
• Some of the problems with GP are the variable methodology in establishing a diagnosis and the lack of validated markers for pyloric function.
• Response to dilatation may indicate a higher likelihood of responding to more invasive treatment.
• “With PyD alone, response rates were higher in children (71%–95%) than adults (27%–53%) with CRE balloon.”

My take (borrowed in part from the authors): “Symptom improvements presented across multiple studies should be interpreted with caution given the lack of controlled data and risk of bias… However, robust randomized placebo-controlled trials are essential to determining the true efficacy of pyloric dilation in gastroparesis.” The higher reported response rates in children could be related to higher rates of more transient disorders.

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