Gastroenterology Section, Department of Medicine, Temple University School of Medicine, 3401 N Broad Street, Parkinson Pavilion 8th floor, Philadelphia, PA, 19140, USA.
Division of Gastroenterology, Hepatology, and Nutrition, Winthrop University Hospital, Mineola, NY, USA.
Dig Dis Sci. 2018 Sep;63(9):2405-2412. doi: 10.1007/s10620-018-4976-9. Epub 2018 Feb 22.
Gastric per oral endoscopic myotomy (G-POEM) of the pylorus is a technique that is recently being used to treat gastroparesis. Our aim was to report our experience in performing G-POEM for refractory gastroparesis of different etiologies and determine symptom improvement.
Thirteen patients undergoing G-POEM are reported. Pre- and post-procedure gastric emptying study (GES) and PAGI-SYM for symptom severity were obtained. Patients underwent G-POEM by creating a submucosal tunnel starting in the greater curvature of the distal antrum and extending it to the beginning of the duodenal bulb, followed by a full thickness pyloromyotomy.
All 13 gastroparesis patients successfully underwent G-POEM (one diabetic [DGp], four idiopathic [IGp], eight postsurgical [PSGp]). Postsurgical patients included 4 s/p esophagectomy for esophageal cancer, 3 s/p Nissen fundoplication, and 1 s/p esophagectomy for achalasia. There were no procedure-related side effects. Of 11 patients completing follow-up questionnaires, eight were improved subjectively (four patients reported considerably better, four patients somewhat better, one unchanged, and two worse). Individual symptom severity scores tended to improve, particularly vomiting, retching, and loss of appetite. Of six patients that had post-G-POEM GES; GES improved in four, unchanged in one, and worsened in one).
G-POEM for treatment of refractory gastroparesis appears to be a feasible and safe technique that can be successfully performed in patients with a variety of etiologies including different types of postsurgical gastroparesis. Our initial experience suggests that the majority of patients report some improvement in symptoms, particularly symptoms of vomiting, retching, and loss of appetite. Further experience is needed to determine the efficacy and safety of G-POEM and predict those who best respond to this treatment.
胃经口内镜肌切开术（G-POEM）是一种最近用于治疗胃轻瘫的技术。我们的目的是报告我们在治疗不同病因难治性胃轻瘫时进行 G-POEM 的经验，并确定症状改善情况。
报告了 13 例接受 G-POEM 的患者。在术前和术后进行胃排空研究（GES）和 PAGI-SYM 以评估症状严重程度。患者通过在远端胃窦的大弯侧创建黏膜下隧道开始进行 G-POEM，并将其延伸至十二指肠球部起始处，然后进行全层幽门肌切开术。
所有 13 例胃轻瘫患者均成功接受了 G-POEM（1 例糖尿病性胃轻瘫[DGp]，4 例特发性胃轻瘫[IGp]，8 例术后胃轻瘫[PSGp]）。术后患者包括 4 例食管癌根治术后，3 例胃底折叠术和 1 例贲门失弛缓症根治术后。无与手术相关的副作用。在完成随访问卷的 11 例患者中，8 例主观上得到改善（4 例报告明显改善，4 例有所改善，1 例无变化，2 例恶化）。个别症状严重程度评分趋于改善，特别是呕吐、恶心和食欲不振。在 6 例接受 G-POEM 后进行 GES 的患者中，4 例 GES 改善，1 例无变化，1 例恶化）。
G-POEM 治疗难治性胃轻瘫似乎是一种可行且安全的技术，可成功应用于各种病因的患者，包括不同类型的术后胃轻瘫。我们的初步经验表明，大多数患者报告症状有所改善，特别是呕吐、恶心和食欲不振等症状。需要进一步的经验来确定 G-POEM 的疗效和安全性，并预测哪些患者对这种治疗反应最佳。
