Division of Digestive Diseases, Emory University, 1365 Clifton Road, B1262, Atlanta, GA, 30322, USA.
Department of Gastroenterology, Renji Hospital, Jiaotong University School of Medicine, Shanghai, China.
Surg Endosc. 2017 Nov;31(11):4617-4624. doi: 10.1007/s00464-017-5524-y. Epub 2017 Apr 13.
Prior studies show promising results of the gastric peroral endoscopic pyloromyotomy (G-POEM) procedure for treatment of refractory gastroparesis. One major technical challenge involved in this procedure is identifying the pyloric muscular ring (PMR). The aim of this study is to establish a reliable method for identification of the PMR during G-POEM.
Fluoroscopy-guided G-POEM was performed by placing an endoclip at the 9 to 11'o clock position at the pylorus for identification of PMR. Conventional G-POEM was performed by observation of blue colored mucosa at the pylorus area as an indirect marker for PMR. The degree of the PMR identification was graded into well identified, identified, and not identified based on the appearance of the PMR. Procedure times were accurately documented. Gastroparesis cardinal symptoms index and gastric emptying scintigraphy were evaluated before and after the procedure.
Fourteen patients were studied, seven underwent fluoroscopy-guided G-POEM, and seven patients underwent conventional G-POEM. All procedures achieved technical success and no adverse events occurred. In the seven patients who underwent fluoroscopy-guided G-POEM, the PMR was well identified in four patients and identified in three patients. In the seven patients who underwent conventional G-POEM, the PMR was identified in four patients and not identified in three patients. The average time to complete the fluoroscopy-guided G-POEM was significantly shorter than that of the conventional G-POEM.
Fluoroscopy-guided G-POEM by placement of an endoclip at the pylorus was a reliable and safe method to direct the orientation of the submucosal tunnel, to facilitate the location of the PMR, and to shorten the procedure time.
先前的研究表明，胃经口内镜下幽门肌切开术（G-POEM）治疗难治性胃轻瘫效果良好。该手术的一个主要技术挑战是识别幽门肌环（PMR）。本研究旨在建立一种在 G-POEM 过程中识别 PMR 的可靠方法。
在幽门 9 点至 11 点位置放置内镜夹，通过透视引导 G-POEM 以识别 PMR。通过观察幽门区域蓝色黏膜作为 PMR 的间接标志物进行常规 G-POEM。根据 PMR 的外观，将 PMR 的识别程度分为良好识别、识别和未识别。准确记录手术时间。在手术前后评估胃轻瘫 cardinal 症状指数和胃排空闪烁扫描。
研究了 14 名患者，7 名患者接受透视引导 G-POEM，7 名患者接受常规 G-POEM。所有手术均获得技术成功，无不良事件发生。在接受透视引导 G-POEM 的 7 名患者中，PMR 在 4 名患者中得到良好识别，在 3 名患者中得到识别。在接受常规 G-POEM 的 7 名患者中，PMR 在 4 名患者中得到识别，在 3 名患者中未得到识别。完成透视引导 G-POEM 的平均时间明显短于常规 G-POEM。
在幽门放置内镜夹引导透视下 G-POEM 是一种可靠且安全的方法，可指导黏膜下隧道的方向，便于识别 PMR，并缩短手术时间。
