1. Resolution of Post-Operative Delayed
Gastric Emptying (DGE) with Acupuncture
Michael M. Rothkopf, MD, FACN
Lisa Haverstick RD, Eleni Pellazgu, APN
Atlantic Health System
Metabolic Medicine Center
Morristown, NJ
National Board of Physician Nutrition Specialists
2. 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
6. 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
7. 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
8. 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)
9. Li H, er al. Acupuncture and regulation of gastrointestinal function.
World J Gastroenterol 2015; 21(27): 8304-8313
10.
11. 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.
THANK YOU!
