Gastric peroral endoscopic pyloromyotomy for decompensated gastroparesis: comprehensive motility analysis in relation to treatment outcomes.
Gastric peroral endoscopic pyloromyotomy for decompensated gastroparesis: comprehensive motility analysis in relation to treatment outcomes.
复制标题
胃经口内镜幽门肌切开术治疗失代偿性胃轻瘫：与治疗结果相关的综合动力分析。
DOI：
10.1055/a-1311-0859
复制
发表时间：
2021-03
影响因子：
2.6
通讯作者：
Masclee AAM
中科院分区：
文献类型：
--
作者：
Conchillo JM;Straathof JWA;Mujagic Z;Brouns JH;Bouvy ND;Keszthelyi D;Masclee AAM
背景和研究目的没有可靠的数据预测胃轻瘫（GP）患者从经口胃镜幽门肌切开术（G-POEM）中获益最多。本研究的目的是评估十二指肠前运动模式和幽门扩张是否可以预测失代偿GP患者G-POEM的结果。患者和方法在一项开放标签研究中，如果按照标准化的逐步治疗方案进行治疗失败，GP和难治性症状的患者有资格接受G-POEM治疗。基线评估包括胃轻瘫主要症状指数（GCSI）、c13 -辛酸胃排空呼气试验和高分辨率十二指肠压力测定。在基线和手术后3个月使用EndoFlip测量幽门扩张度。采用逻辑回归分析对可能的预测因素进行探索性分析。结果24例失代偿GP患者行G-POEM。基线时，78.3%和61.9%的患者分别表现为窦性运动障碍和神经性运动模式。技术成功率100%（24/24）。G-POEM术后3、6、12个月GCSI均值显著改善（P = 0.01）。与基线相比，中位扩张指数（DI）显著改善（7.5 [6.9;11.7]vs. 5.3[3.1;8.1], P = 0.004）。6个月时的临床反应与幽门DI改善之间存在显著相关性（P = 0.003）。在探索性分析中没有发现G-POEM后临床反应的潜在预测因素。结论G-POEM改善了失代偿GP患者的幽门扩张模式。G-POEM治疗后6个月的临床反应与幽门扩张改善有关。然而，没有从十二指肠前运动模式或幽门扩张中确定反应的潜在预测因素。
Background and study aims There are no reliable data to predict which patients with gastroparesis (GP) would benefit the most from gastric peroral endoscopic pyloromyotomy (G-POEM). The aim of the present study was to assess whether antro-duodenal motility patterns and pyloric distensibility can predict the outcome of G-POEM in patients with decompensated GP. Patients and methods In an open-label study, patients with GP and refractory symptoms were eligible for treatment with G-POEM if treatment attempts according to a standardized stepwise protocol had failed. Baseline assessment included Gastroparesis Cardinal Symptom Index (GCSI), C13-octanoic gastric emptying breath test and high-resolution antro-duodenal manometry. Pyloric distensibility using EndoFlip measurements was assessed at baseline and 3 months after the procedure. Explorative analyses were performed on potential predictors of response using logistic regression analyses. Results Twenty-four patients with decompensated GP underwent G-POEM. At baseline, 78.3 % and 61.9 % of patients showed antral hypomotility and neuropathic motor patterns, respectively. The technical success rate was 100 % (24/24). Mean GCSI improved significantly at 3, 6, and 12 months after G-POEM ( P = 0.01). Median distensibility index (DI) improved significantly as compared with baseline (7.5 [6.9;11.7] vs. 5.3[3.1;8.1], P = 0.004). A significant correlation was found between clinical response at 6 months and pyloric DI improvement ( P = 0.003). No potential predictors of clinical response after G-POEM could be identified in an explorative analysis. Conclusions G-POEM improved pyloric distensibility patterns in patients with decompensated GP. Clinical response at 6 months after G-POEM was associated with pyloric distensibility improvement. However, no potential predictors of response could be identified from either antro-duodenal motility patterns or pyloric distensibility.