Gastric Peroral Endoscopic Myotomy (G-POEM) as a Treatment for Refractory Gastroparesis: Long-Term Outcomes.
Gastric Peroral Endoscopic Myotomy (G-POEM) as a Treatment for Refractory Gastroparesis: Long-Term Outcomes.
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胃经口内窥镜肌切开术 (G-POEM) 治疗难治性胃轻瘫：长期结果
DOI：
10.1155/2018/6409698
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发表时间：
2018
影响因子：
2.7
通讯作者：
Zhou P
中科院分区：
文献类型：
--
作者：
Xu J;Chen T;Elkholy S;Xu M;Zhong Y;Zhang Y;Chen W;Qin W;Cai M;Zhou P
背景与目的胃经口内镜肌切开术（G-POEM）是治疗难治性胃轻瘫的一种新的微创治疗方法。本研究报告了亚洲人群中G-POEM后的长期结局和成功结局的可能预测因素。方法这是一项回顾性单中心研究，纳入了2016年8月至2017年10月接受G-POEM治疗难治性胃轻瘫的16例患者。该研究包括11名男性和5名女性;此外，13名患者患有术后胃轻瘫，3名患者患有糖尿病。纳入的患者患有重度难治性胃轻瘫，表现为胃轻瘫主要症状指数（GCSI）评分≥20，胃排空造影（GES）显示有延迟迹象。主要结局参数是对手术长期临床疗效的评估。次要结果参数是检测成功的可能预测因素，并确定这些预测因素的临界值。结果100%的患者获得了技术成功，平均手术时间为45.25±12.96 min。在中位随访14.5个月期间，对所有患者的长期临床反应进行了评估。13例（81.25%）患者获得临床成功。与基线值相比，术后GCSI评分和GES值显著降低，P值分别<0.0001和0.012。单变量回归分析显示GCSI和GES与患者未来的临床结局显着相关，但这一发现在多变量分析中并未得到证实。GCSI临界评分≤30具有高灵敏度，预测手术成功的阴性预测值（NPV）为100%。GES（半排空时间≤221.6 min，2 h滞留率≤78.6%）特异性高，阳性预测值（PPV）为100%。结论G-POEM是一种安全有效的治疗方法，远期有效率为81.6%。GCSI和GES可以作为良好的预测措施。
Background and Aims Gastric peroral endoscopic myotomy (G-POEM) has been regarded as a novel and minimally invasive therapy for refractory gastroparesis. This study reports the long-term outcomes and possible predictive factors for successful outcomes after G-POEM in an Asian population. Methods This is a retrospective single-centre study of 16 patients who underwent G-POEM for refractory gastroparesis from August 2016 to October 2017. This study included 11 males and 5 females; in addition, 13 patients had postsurgical gastroparesis, and 3 patients had diabetes. The patients included had severe and refractory gastroparesis, as indicated by a Gastroparesis Cardinal Symptom Index (GCSI) score ≥20, and evidence of a delay on gastric emptying scintigraphy (GES). The primary outcome parameter was an assessment of the long-term clinical efficacy of the procedure. The secondary outcome parameter was the detection of possible predictive factors for success and the determination of cut-off values for such predictors. Results Technical success was achieved in 100% of the patients, with a mean procedure time of 45.25±12.96 min. The long-term clinical response was assessed in all patients during a median follow-up of 14.5 months. Clinical success was achieved in 13 (81.25%) patients. There was a significant reduction in the GCSI scores and GES values after the procedure compared to the baseline values, with P values of <0.0001 and 0.012, respectively. Univariate regression analysis showed that the GCSI and GES had significant associations with the future clinical outcomes of the patients, but this finding was not confirmed in multivariate analysis. A GCSI cut-off score of ≤30 had a high sensitivity and a negative predictive value (NPV) of 100% for predicting a successful procedure. GES (half emptying time ≤221.6 min and 2-hour retention ≤78.6%) had a high specificity and a positive predictive value (PPV) of 100%. Conclusions G-POEM is a safe and effective treatment option with a long-term efficacy of 81.6%. GCSI and GES could serve as good predictive measures.
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