Gastric Peroral Endoscopic Pyloromyotomy for Infants With Congenital Hypertrophic Pyloric Stenosis
Gastric Peroral Endoscopic Pyloromyotomy for Infants With Congenital Hypertrophic Pyloric Stenosis
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DOI：
10.14309/ajg.0000000000001973
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发表时间：
2022-08
期刊：
影响因子：
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通讯作者：
Hanhua Zhang;Zuqiang Liu;Liyun Ma;Quanlin Li;Ying Huang;K. Dong;Hong Ye;Jiangbin Liu;Haifeng Liu;X. Ren;Hongbin Yang;Chongzhi Hou;Kuku Ge;Hua Wang;Pinghong Zhou;Ying Fang
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文献类型：
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作者：
Hanhua Zhang;Zuqiang Liu;Liyun Ma;Quanlin Li;Ying Huang;K. Dong;Hong Ye;Jiangbin Liu;Haifeng Liu;X. Ren;Hongbin Yang;Chongzhi Hou;Kuku Ge;Hua Wang;Pinghong Zhou;Ying Fang
简介：先天性肥厚性幽门狭窄（CHPS），最常见的婴儿疾病，需要手术干预，常规治疗开放或腹腔镜幽门肌切开术。最近，胃经口内镜幽门肌切开术（G-POEM）已用于成人胃轻瘫。我们的目的是评价G-POEM治疗婴儿CHPS的有效性和安全性。方法：我们回顾了2019年1月至2020年12月期间中国3家三级儿童内镜中心21例G-POEM治疗患者的数据。总结了临床特征、手术相关参数、围手术期管理和随访结果。结果：所有患者均成功完成G-POEM。中位手术时间为49（14-150）分钟。19例沿胃大弯沿着建立黏膜下隧道成功，2例因困难改沿胃小弯建立。无围手术期主要不良事件发生。轻微不良事件包括5例无意义的粘膜损伤和1例粘膜切口闭合不满意。术后第3天，所有患者的上消化道造影剂均顺利通过幽门。术后3个月生长曲线恢复正常。在中位随访期25.5（14-36）个月内，任何患者均未出现复发的临床症状。讨论：G-POEM是可行的，安全的，有效的CHPS婴儿，在短期随访的临床反应令人满意。应进行进一步的多中心研究，以比较这种微创技术与开放或腹腔镜幽门环肌切开术的长期结局。
INTRODUCTION: Congenital hypertrophic pyloric stenosis (CHPS), the most common infantile disease requiring surgical intervention, is routinely treated with open or laparoscopic pyloromyotomy. Recently, gastric peroral endoscopic pyloromyotomy (G-POEM) has been used for adult gastroparesis. We aimed to evaluate the efficacy and safety of G-POEM in treating infantile CHPS. METHODS: We reviewed data from 21 G-POEM-treated patients at 3 tertiary children's endoscopic centers in China between January 2019 and December 2020. Clinical characteristics, procedure-related parameters, perioperative management, and follow-up outcomes were summarized. RESULTS: G-POEM was performed successfully in all patients. The median operative duration was 49 (14–150) minutes. The submucosal tunnels were successfully established along the greater curvature of the stomach in 19 cases, and 2 cases were switched to the lesser curvature because of difficulty. No perioperative major adverse events occurred. Minor adverse events included inconsequential mucosal injury in 5 cases and unsatisfactory closure of the mucosal incision in 1 case. Upper gastrointestinal contrast radiography in all patients showed smooth passage of the contrast agent through the pylorus on postoperative day 3. The growth curves of the patients reached normal levels 3 months after the procedure. No recurrent clinical symptoms occurred in any patient during the median follow-up period of 25.5 (14–36) months. DISCUSSION: G-POEM is feasible, safe, and effective for infants with CHPS, with satisfactory clinical responses over a short-term follow-up. Further multicenter studies should be performed to compare the long-term outcomes of this minimally invasive technique with open or laparoscopic pyloromyotomy.