Long-term Outcome of Gastric Per-Oral Endoscopic Pyloromyotomy in Treatment of Gastroparesis
Long-term Outcome of Gastric Per-Oral Endoscopic Pyloromyotomy in Treatment of Gastroparesis
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DOI：
10.1016/j.cgh.2020.05.039
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发表时间：
2021-03-18
影响因子：
12.6
通讯作者：
Cai, Qiang
中科院分区：
文献类型：
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作者：
Abdelfatah, Mohamed M.;Noll, Alan;Cai, Qiang
背景与目的：经口胃镜幽门肌切开术（GPOEM）是一种很有前途的治疗胃轻瘫的方法。关于这种手术的长期结果的数据很少。我们研究了GPOEM治疗难治性胃轻瘫患者的长期疗效。方法：我们对2015年6月至2019年3月在单一中心接受GPOEM治疗难治性胃轻瘫的所有患者（n = 97）进行了回顾性病例系列研究；90例患者随访时间超过3个月，纳入我们的最终分析。我们收集了胃轻瘫主要症状指数（GCSI）评分（测量餐后饱腹感或早期饱腹感、恶心、呕吐和腹胀）和SF-36问卷评分（测量生活质量）的数据。主要终点是对GPOEM的临床反应，定义为GCSI平均总分下降至少1分，至少2个主要症状亚量表下降超过25%。复发定义为在初始完全缓解后至少2个月恢复到基线GCSI或GCSI评分在3分或以上。次要结局是预测GPOEM失败的因素（6个月内无反应或胃轻瘫复发）。结果：在初始随访（GPOEM后3 - 6个月），73例患者（81.1%）有临床反应，SF-36问卷得分显著增加（表明生活质量提高），而17例患者（18.9%）无反应。术后6个月复发率为7.1%。12个月时，8.3%的患者复发。24个月时，研究中4.8%的患者复发。在36个月时，14.3%的患者在研究中复发。对于最初有临床反应的患者，该反应的损失率为每年12.9%。在单因素和多因素回归分析中，较长的胃轻瘫持续时间降低了GPOEM的应答几率（优势比[OR]， 0.092; 95% CI, 1.04-1.3; P = .001）。在多因素logistic回归中，高bmi患者GPOEM失败的几率增加（OR, 1.097; 95% CI, 1.022-1.176; P = 0.010），接受精神药物治疗的患者GPOEM失败的风险更高（OR, 1.33; 95% CI, 0.110-1.008; P = 0.052）。结论：对90例接受GPOEM治疗难治性胃轻瘫的患者进行回顾性分析，81.1%的患者在手术初期随访时有临床反应。GPOEM治疗1年后，69.1%的患者有临床反应，85.2%的患者维持了临床反应。患者在手术后维持了长达3年的临床反应和改善的生活质量。高BMI和长时间胃轻瘫与GPOEM失败相关。
BACKGROUND & AIMS: Gastric per oral endoscopic pyloromyotomy (GPOEM) is a promising treatment for gastro-paresis. There are few data on the long-term outcomes of this procedure. We investigated longterm outcomes of GPOEM treatment of patients with refractory gastroparesis.METHODS: We conducted a retrospective case-series study of all patients who underwent GPOEM for refractory gastroparesis at a single center (n = 97), from June 2015 through March 2019; 90 patients had more than 3 months follow-up data and were included in our final analysis. We collected data on gastroparesis cardinal symptom index (GCSI) scores (measurements of postprandial fullness or early satiety, nausea and vomiting, and bloating) and SF-36 questionnaire scores (measures quality of life). The primary outcome was clinical response to GPOEM, defined as a decrease of at least 1 point in the average total GCSI score with more than a 25% decrease in at least 2 subscales of cardinal symptoms. Recurrence was defined as a return to baseline GCSI or GCSI scores of 3 or more for at least 2 months after an initial complete response. The secondary outcome was the factors that predict GPOEM failure (no response or gastroparesis recurrence within 6 months).RESULTS: At initial follow-up (3 to 6 months after GPOEM), 73 patients (81.1%) had a clinical response and significant increases in SF-36 questionnaire scores (indicating increased quality of life) whereas 17 patients (18.9%) had no response. Six months after GPOEM, 7.1% had recurrence. At 12 months, 8.3% of patients remaining in the study had recurrence. At 24 months, 4.8% of patients remaining in the study had a recurrence. At 36 months, 14.3% of patients remaining in the study had recurrence. For patients who experienced an initial clinical response, the rate of loss of that response per year was 12.9%. In the univariate and multivariate regression analysis, a longer duration of gastroparesis reduced the odds of response to GPOEM (odds ratio [OR], 0.092; 95% CI, 1.04-1.3; P = .001). On multivariate logistic regression, patients with high BMIs had increased odds of GPOEM failure (OR, 1.097; 95% CI, 1.022-1.176; P = .010) and patients receiving psychiatric medications had a higher risk of GPOEM failure (OR, 1.33; 95% CI, 0.110-1.008; P = .052).CONCLUSIONS: In retrospective analysis of 90 patients who underwent GPOEM for refractory gastroparesis, 81.1% had a clinical response at initial follow-up of their procedure. 1 year after GPOEM, 69.1% of all patients had a clinical response and 85.2% of initial responders maintained a clinical response. Patients maintained a clinical response and improved quality of life for as long as 3 years after the procedure. High BMI and long duration gastroparesis were associated with failure of GPOEM.