Selecting optimal patients with gastroparesis for G-POEM procedure.
Selecting optimal patients with gastroparesis for G-POEM procedure.
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DOI：
10.1136/gutjnl-2021-324631
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发表时间：
2022-04
期刊：
影响因子：
24.5
通讯作者：
Camilleri, Michael
中科院分区：
文献类型：
--
作者：
Zheng, Ting;Camilleri, Michael
In a very welcome article, Vosoughi and colleagues 1 describe the experience from five tertiary centres (four in the USA, one in Brazil) regarding the outcomes of the gastric peroral endoscopic myotomy (G-POEM) procedure for the treatment of 80 patients with symptomatic gastroparesis refractory to standard medical therapy and confirmed by impaired gastric emptying (gastric retention> 20% at 4 hours). The primary endpoint was clinical success, defined as at least one score decrease in the Gastroparesis Cardinal Symptom Index (GCSI) with≥ 25% decrease in two subscales at 12 months. From this open-label, uncontrolled experience, the authors concluded that G-POEM was only modestly effective in patient with gastroparesis, with a clinical success rate of 56% at 12 months. However, serial assessment documented that the response to G-POEM was durable over the 12-month follow-up. This study also identified that baseline GCSI score> 2.6 and baseline gastric retention greater than 20% at 4 hours, as well as responsiveness 1 month after the G-POEM procedure were independent predictors of clinical success 12 months after G-POEM. The study has many strengths including the sample size of 80, of which 94% had completed 12-month follow-up, use of the validated GCSI score and subscales, and assessment of quality of life, using the 36-Item Short Form Questionnaire, at baseline and 1, 3, 6 and 12 months after G-POEM. Gastric emptying study was also performed before and 3 months after the procedure. The study also addressed important limitations from prior studies, which were mostly retrospective, had small sample size and, at times, had unclearly defined eligibility criteria. The authors appropriately conclude that G-POEM is a safe procedure, with modest but durable overall effectiveness in the treatment of refractory gastroparesis, and they recommend further studies to identify the best candidates for G-POEM and discourage unselective use of this procedure.A previously published article 2 cited evidence that unusually prolonged and intense tonic contraction, termed ‘pylorospasm’, occurs significantly more often in diabetic patients than in healthy controls (14/24 and 1/12, respectively), suggesting that spasm or poor distensibility of the pylorus are components of the pathophysiology of gastroparesis. Other contributors to delayed gastric emptying are antral hypomotility and/or intestinal dysmotility. 3
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影响因子：
3.5
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通讯作者：
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