Hepatology and Gastroenterology Division, Yokohama City University School of Medicine, Yokohama, Japan.
Department of Medical Education, Yokohama City University School of Medicine, Yokohama, Japan.
Neurogastroenterol Motil. 2017 Dec;29(12). doi: 10.1111/nmo.13127. Epub 2017 Jun 20.
Chronic intestinal pseudo-obstruction (CIPO) is an intractable rare digestive disease manifesting persistent small bowel distension without any mechanical cause. Intestinal decompression is a key treatment, but conventional method including a trans-nasal small intestinal tube is invasive and painful. Therefore, a less invasive and tolerable new decompression method is urgently desired. We conducted a pilot study and assessed the efficacy and safety of percutaneous endoscopic gastro-jejunostomy (PEG-J) decompression therapy in CIPO patients.
Seven definitive CIPO patients (2 males and 5 females) were enrolled. All patients received PEG-J decompression therapy. The number of days with any abdominal symptoms in a month (NODASIM), body mass index (BMI), serum albumin level (Alb), and small intestinal volume before and after PEG-J were compared in all patients.
Percutaneous endoscopic gastro-jejunostomy was well tolerated and oral intake improved in all patients. NODASIM has significantly decreased (24.3 vs 9.3 days/months) and BMI/Alb have significantly increased (14.9 vs 17.2 kg/m and 2.6 vs 3.8 g/dL, respectively), whereas total volume of the small intestine has not significantly reduced (4.05 vs 2.59 L, P=.18). Reflux esophagitis and chemical dermatitis were observed in one case but was successfully treated conservatively.
CONCLUSIONS & INFERENCES: Percutaneous endoscopic gastro-jejunostomy decompression therapy can contribute greatly to improvement of abdominal symptoms and nutritional status in CIPO patients. Although sufficient attention should be paid to acid reflux symptoms, PEG-J has the potential to be a non-invasive novel decompression therapy for CIPO available at home. However, accumulation of more CIPO patients and long-term observation are needed (UMIN000017574).
慢性肠道假性梗阻（CIPO）是一种顽固性罕见的消化系统疾病，表现为持续的小肠扩张而无任何机械原因。肠道减压是一种关键的治疗方法，但包括经鼻小肠管在内的传统方法具有侵袭性和痛苦。因此，迫切需要一种微创且耐受性更好的新减压方法。我们进行了一项试点研究，评估了经皮内镜胃空肠造口术（PEG-J）减压治疗在 CIPO 患者中的疗效和安全性。
纳入了 7 名确诊的 CIPO 患者（2 名男性，5 名女性）。所有患者均接受了 PEG-J 减压治疗。比较所有患者治疗前后的每月任何腹部症状天数（NODASIM）、体重指数（BMI）、血清白蛋白水平（Alb）和小肠体积。
所有患者均能耐受经皮内镜胃空肠造口术，且口服摄入改善。NODASIM 明显减少（24.3 天/月 vs 9.3 天/月），BMI/Alb 明显增加（14.9 千克/米 vs 17.2 千克/米和 2.6 克/分升 vs 3.8 克/分升），而小肠总容积无明显减少（4.05 升 vs 2.59 升，P=0.18）。一例患者出现反流性食管炎和化学性皮炎，但经保守治疗成功治愈。
经皮内镜胃空肠造口术减压治疗可显著改善 CIPO 患者的腹部症状和营养状况。尽管应充分注意胃酸反流症状，但 PEG-J 具有成为一种非侵入性新型 CIPO 减压治疗方法的潜力，可在国内应用。然而，需要积累更多的 CIPO 患者并进行长期观察（UMIN000017574）。
