EndoFLIP and Pyloric Dilation for Gastroparesis Symptoms Refractory to Pyloromyotomy/Pyloroplasty
EndoFLIP and Pyloric Dilation for Gastroparesis Symptoms Refractory to Pyloromyotomy/Pyloroplasty
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DOI：
10.1007/s10620-020-06510-0
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发表时间：
2020-08-04
影响因子：
3.1
通讯作者：
Parkman, Henry P.
中科院分区：
文献类型：
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作者：
Jehangir, Asad;Malik, Zubair;Parkman, Henry P.
背景胃轻瘫患者可能因慢性顽固性症状接受幽门环肌切开术/幽门成形术。但是，有些患者有持续的症状。尚不清楚球囊扩张是否可以改善其症状。目的：我们旨在（1）评估幽门经内镜（TTS）球囊扩张是否导致对幽门肌切开术/幽门成形术反应不佳的胃轻瘫患者的症状改善，（2）确定扩张前这些患者的内镜功能性管腔成像探头（EndoFLIP）特征。方法2019年2月至2020年3月收治的幽门环肌切开术/幽门成形术难治性重度胃轻瘫患者，在使用EndoFLIP评估幽门特征后进行TTS扩张。患者在术前完成胃轻瘫主要症状指数（GCSI），并在随访时完成GCSI和临床患者分级评估量表（CPGAS）。结果13例（10名女性）幽门环肌切开/幽门成形术后出现严重胃轻瘫症状（平均GCSI总分3.4 ± 0.3）的患者（平均年龄45.2 ± 5.1岁）接受了幽门TTS扩张术。总体而言，在1个月随访时症状有所改善（平均GCSI总分3.0 +/- 0.4，平均CPGAS评分1.6 +/-0.5，p < 0.05），5名（38%）患者报告症状有所改善/中度改善。症状改善的患者在30 ml、40 ml和50 ml下的幽门EndoFLIP扩张前扩张性低于几乎没有改善/没有改善的患者（allp < 0.05）。结论在幽门环肌切开术/幽门成形术后有难治性症状的胃轻瘫患者中，约三分之一的患者幽门TTS扩张改善了症状。症状改善的患者在EndoFLIP上的扩张前幽门扩张性较低，表明肌切开术不完全、幽门肌肉再生或幽门狭窄。对于幽门肌切开术/幽门成形术难治的胃轻瘫症状患者，幽门EndoFLIP后TTS扩张似乎是一种有希望的治疗方法。
Background Gastroparesis patients may undergo pyloromyotomy/pyloroplasty for chronic refractory symptoms. However, some patients have persistent symptoms. It is unknown if balloon dilation may improve their symptoms. Aims We aimed to (1) assess if pyloric through-the-scope (TTS) balloon dilation results in symptom improvement in gastroparesis patients with suboptimal response to pyloromyotomy/pyloroplasty and (2) determine endoscopic functional luminal imaging probe (EndoFLIP) characteristics of these patients before dilation. Methods Patients with severe gastroparesis refractory to pyloromyotomy/pyloroplasty seen from 2/2019 to 3/2020 underwent pyloric TTS dilation after assessing the pyloric characteristics using EndoFLIP. Patients completed Gastroparesis Cardinal Symptom Index (GCSI) pre-procedurally, and GCSI and Clinical Patient Grading Assessment Scale (CPGAS) on follow-ups. Results Thirteen (ten females) patients (mean age 45.2 +/- 5.1 years) with severe gastroparesis symptoms (mean GCSI total score 3.4 +/- 0.3) after pyloromyotomy/pyloroplasty underwent pyloric TTS dilation. Overall, there was improvement in symptoms at 1-month follow-up (mean GCSI total score 3.0 +/- 0.4, mean CPGAS score 1.6 +/- 0.5,p < 0.05 for both), with five (38%) patients reporting symptoms somewhat/moderately better. The patients with symptom improvement had lower pre-dilation pyloric EndoFLIP distensibility at 30 ml, 40 ml, and 50 ml than patients with little/no improvement (allp < 0.05). Conclusions In gastroparesis patients with refractory symptoms after pyloromyotomy/pyloroplasty, pyloric TTS dilation improved symptoms in about a third of the patients. Patients with symptom improvement had lower pre-dilation pyloric distensibility on EndoFLIP suggesting incomplete myotomy, pyloric muscle regeneration, or pyloric stricture. Pyloric EndoFLIP followed by TTS dilation seems to be a promising treatment for some patients with gastroparesis symptoms refractory to pyloromyotomy/pyloroplasty.