Efficacy of percutaneous endoscopic gastro-jejunostomy (PEG-J) decompression therapy for patients with chronic intestinal pseudo-obstruction (CIPO)
Efficacy of percutaneous endoscopic gastro-jejunostomy (PEG-J) decompression therapy for patients with chronic intestinal pseudo-obstruction (CIPO)
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DOI：
10.1111/nmo.13127
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发表时间：
2017-12-01
影响因子：
3.5
通讯作者：
Nakajima, A.
中科院分区：
文献类型：
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作者：
Ohkubo, H.;Fuyuki, A.;Nakajima, A.
背景慢性假性肠梗阻（CIPO）是一种罕见的难治性消化系统疾病，表现为无任何机械原因的持续性小肠扩张。肠道减压是关键的治疗方法，但包括经鼻小肠管在内的传统方法具有侵入性且痛苦。因此，迫切需要一种创伤小、耐受性好的新型减压方法。我们进行了一项试点研究，评估了经皮内镜下胃空肠吻合术 (PEG-J) 减压治疗对 CIPO 患者的疗效和安全性。方法 纳入 7 名确诊的 CIPO 患者（2 名男性和 5 名女性）。所有患者均接受PEG-J减压治疗。比较所有患者PEG-J前后一个月内出现任何腹部症状的天数（NODASIM）、体重指数（BMI）、血清白蛋白水平（Alb）和小肠体积。结果所有患者经皮内镜胃空肠吻合术耐受性良好，经口摄入量均有所改善。 NODASIM 显着下降（24.3 vs 9.3 天/月），BMI/Alb 显着增加（分别为 14.9 vs 17.2kg/m(2) 和 2.6 vs 3.8g/dL），而小肠总体积没有显着减少（4.05 vs 2.59L，P=.18）。 1例出现反流性食管炎和化学性皮炎，经保守治疗成功。结论与推论：经皮内镜下胃空肠吻合减压治疗对CIPO患者腹部症状和营养状况的改善有很大作用。尽管应充分关注胃酸反流症状，但 PEG-J 有潜力成为一种在家中即可使用的 CIPO 非侵入性新型减压疗法。但还需要更多CIPO患者的积累和长期观察（UMIN000017574）。
BackgroundsChronic intestinal pseudo-obstruction (CIPO) is an intractable rare digestive disease manifesting persistent small bowel distension without any mechanical cause. Intestinal decompression is a key treatment, but conventional method including a trans-nasal small intestinal tube is invasive and painful. Therefore, a less invasive and tolerable new decompression method is urgently desired. We conducted a pilot study and assessed the efficacy and safety of percutaneous endoscopic gastro-jejunostomy (PEG-J) decompression therapy in CIPO patients.MethodsSeven definitive CIPO patients (2 males and 5 females) were enrolled. All patients received PEG-J decompression therapy. The number of days with any abdominal symptoms in a month (NODASIM), body mass index (BMI), serum albumin level (Alb), and small intestinal volume before and after PEG-J were compared in all patients.ResultsPercutaneous endoscopic gastro-jejunostomy was well tolerated and oral intake improved in all patients. NODASIM has significantly decreased (24.3 vs 9.3days/months) and BMI/Alb have significantly increased (14.9 vs 17.2kg/m(2) and 2.6 vs 3.8g/dL, respectively), whereas total volume of the small intestine has not significantly reduced (4.05 vs 2.59L, P=.18). Reflux esophagitis and chemical dermatitis were observed in one case but was successfully treated conservatively.Conclusions & InferencesPercutaneous endoscopic gastro-jejunostomy decompression therapy can contribute greatly to improvement of abdominal symptoms and nutritional status in CIPO patients. Although sufficient attention should be paid to acid reflux symptoms, PEG-J has the potential to be a non-invasive novel decompression therapy for CIPO available at home. However, accumulation of more CIPO patients and long-term observation are needed (UMIN000017574).