Gastric electric stimulator versus gastrectomy for the treatment of medically refractory gastroparesis.
Gastric electric stimulator versus gastrectomy for the treatment of medically refractory gastroparesis.
复制标题
胃电刺激器与胃切除术治疗难治性胃轻瘫。
DOI：
10.1007/s00464-022-09191-0
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Samakar,Kamran
中科院分区：
文献类型：
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作者：
Samaan,JamilS;Toubat,Omar;Alicuben,EvanT;Dewberry,Sean;Dobrowolski,Adrian;Sandhu,Kulmeet;Zehetner,Joerg;Lipham,JohnC;Samakar,Kamran
胃电刺激(GES)和腹腔镜胃切除术(LG)是治疗难治性胃轻瘫(MRG)的已知选择，但比较其疗效的数据有限。我们的目标是比较接受GES和前期LG治疗MRG的患者的临床结果，同时检查与GES失败和转换为LG相关的因素。方法我们回顾分析了2003年1月至2017年12月在我所接受GES或LG MRG的连续181例患者。数据收集包括图表回顾和电话跟踪调查。统计分析采用卡方检验、单因素方差分析和多变量Logistic回归分析。结果：130例(72%)患者接受了GES，51例(28%)接受了LG作为主要干预措施。GES患者更容易发生糖尿病胃轻瘫(GES 67%对LG 39%，p<； 0.001)，而原发LG患者更有可能发生术后胃瘫(GES 5%对Lg 43%，p<； 0.001)。术后，原发LG患者的主要住院并发症发生率较高(GES 5%对LG 18%，p= 0.017)，住院时间较长(GES 3对LG 9天，p<； 0.001)。然而，在平均35个月的随访期内，主要发病率、再入院率或死亡率没有差异。多变量回归分析显示，与原发LG患者相比，接受GES作为主要干预措施的患者在随访时报告症状改善的可能性较小，OR为0.160(95%CI 0.048-0.532)。此外，从GES转为LG的患者更有可能将术后胃轻瘫作为主要原因。结论GES作为MRG的一线手术治疗，与LG相比，预后较差。手术后的病因与GES失败的可能性增加有关，在这类患者中，胃大部切除术可能是GES更好的选择。需要进一步的研究来确定MRG手术治疗的患者选择。
BackgroundGastric electrical stimulation (GES) and laparoscopic gastrectomy (LG) are known therapeutic options for medically refractory gastroparesis (MRG) although there are limited data comparing their outcomes. We aim to compare clinical outcomes between patients undergoing GES vs upfront LG for the treatment of MRG while examining factors associated with GES failure and conversion to LG.MethodsWe retrospectively analyzed 181 consecutive patients who underwent GES or LG for MRG at our institution from January 2003 to December 2017. Data collection consisted of chart review and follow-up telephone survey. Statistical analysis utilized Chi-squared, ANOVA, and multivariable logistic regression.ResultsOverall, 130 (72%) patients underwent GES and 51 (28%) LG as primary intervention. GES patients were more likely to have diabetic gastroparesis (GES 67% vs LG 39%,p< 0.001), while primary LG patients were more likely to have post-surgical gastroparesis (GES 5% vs LG 43%,p< 0.001). Postoperatively, primary LG patients had higher rates of major in-hospital morbidity events (GES 5% vs LG 18%,p= 0.017) and longer hospital stays (GES 3 vs LG 9 days,p< 0.001). However, over a mean 35-month follow-up period, there were no differences in the rates of major morbidity, readmissions, or mortality. Multivariable regression analysis revealed patients undergoing GES as a primary intervention were less likely to report improvement in symptoms on follow-up compared to primary LG patients OR 0.160 (95% CI 0.048–0.532). Additionally, patients who converted to LG from GES were more likely to have post-surgical gastroparesis as the primary etiology.ConclusionGES as a first-line surgical treatment of MRG was associated with worse outcomes compared to LG. Post-surgical etiology was associated with an increased likelihood of GES failure, and in such patients, upfront gastrectomy may be a superior alternative to GES. Further studies are needed to determine patient selection for operative treatment of MRG.