Gastric per-oral endoscopic myotomy with antropyloromyotomy in the treatment of refractory gastroparesis: clinical experience with follow-up and scintigraphic evaluation (with video)
Gastric per-oral endoscopic myotomy with antropyloromyotomy in the treatment of refractory gastroparesis: clinical experience with follow-up and scintigraphic evaluation (with video)
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DOI：
10.1016/j.gie.2016.07.050
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发表时间：
2017-01-01
影响因子：
7.7
通讯作者：
Barthet, Marc
中科院分区：
文献类型：
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作者：
Gonzalez, Jean-Michel;Lestelle, Valentin;Barthet, Marc
背景和目的：胃轻瘫是一种慢性衰弱性疾病。我们报告了经口胃内窥镜幽门肌切开术（G-POEM）的经验，目的是评估临床疗效、胃排空演变和程序不良事件。方法：这是一个临床试验系列，包括2014年2月至2015年8月在我们三级中心连续接受G-POEM治疗难治性胃轻瘫的12例患者。纳入的患者病情严重，根据胃轻瘫主要症状指数（GCSI）评分升高和胃排空显像（GES）延迟来定义。G-POEM在幽门上游进行粘膜切口，然后进行粘膜下隧道和幽门肌切开术，随后关闭通道。在5天、1个月和3个月时，根据GCSI评分和对主要症状（恶心、呕吐、腹痛、早饱感和厌食）进行个体化（Likert量表）评估疗效。术后2个月行GES检查。结果：12例患者均成功行G-POEM，技术成功率100%。GCSI显著改善：3.5 +/- 0.8 vs。分别为9 +/- 0.9（1个月）和1.1 +/- 1.5（3个月）（P < 0.001），以及3个月时主要症状的严重程度。临床有效率85%（10/12）。75%的病例GES恢复正常，半排空时间改善（222 +/- 90分钟vs 133 +/- 90分钟，P = 0.03）， 2小时潴留（76% +/- 20% vs 44% +/- 26%, P = 0.009）。没有与手术相关的不良事件。结论：我们报告了一项评估G-POEM治疗难治性胃轻瘫的单中心研究，证明了其可行性、可重复性和安全性，具有良好的临床和科学疗效。
Background and Aims: Gastroparesis is a chronic, debilitating condition. We report an experience conducting gastric per-oral endoscopic pyloromyotomy (G-POEM) with objectives to assess clinical efficacy, gastric emptying evolution, and procedural adverse events.Methods: This was a clinical pilot series on 12 consecutive patients who underwent G-POEM for refractory gastroparesis in our tertiary center between February 2014 and August 2015. Patients included had severe disease as defined by elevated Gastroparesis Cardinal Symptoms Index (GCSI) score and delayed gastric emptying scintigraphy (GES). G-POEM was performed by mucosal incision upstream the pylorus followed by submucosal tunnel and antropyloromyotomy with subsequent access closure. Efficacy was assessed at 5 days, 1 month, and 3 months, based on GCSI score, and individualizing (Likert scale) the main symptoms (nausea, vomiting, abdominal pain, early satiety, and anorexia). GES was performed 2 months after the procedure.Results: G-POEM was successfully performed in all 12 patients, yielding a technical success rate of 100%. Significant improvements in GCSI were observed: 3.5 +/- .8 versus .9 +/- .9 (1 month) and 1.1 +/- 1.5 (3 months), respectively (P < .001), as well as the severity of main symptoms at 3 months. Clinical efficacy was 85% (10/12). GES normalized in 75% of cases, with improvement of half emptying time (222 +/- 90 minutes vs 133 +/- 90 minutes; P = .03) and retention at 2 hours (76% +/- 20% vs 44% +/- 26%; P = .009). There were no adverse events related to the procedure.Conclusion: We report a single-center study evaluating G-POEM for refractory gastroparesis, demonstrating its feasibility, reproducibility, and safety with promising clinical and scintigraphic efficacy.