Service de Gastroentérologie, CHU Limoges, Limoges, France.
CNRS, XLIM, UMR 7252, Limoges, France.
Endoscopy. 2019 Jan;51(1):40-49. doi: 10.1055/a-0628-6639. Epub 2018 Jun 12.
Gastroparesis is a functional disorder with a variety of symptoms that is characterized by delayed gastric emptying in the absence of mechanical obstruction. A recent series of retrospective studies has demonstrated that peroral endoscopic pyloromyotomy (G-POEM) is a promising endoscopic procedure for treating patients with refractory gastroparesis. The aim of this prospective study was to evaluate the feasibility, safety, and efficacy of G-POEM.
20 patients with refractory gastroparesis (10 diabetic and 10 nondiabetic) were prospectively included in the trial. Patients were treated by G-POEM after evaluation of pyloric function using an endoscopic functional luminal imaging probe. Clinical responses were evaluated using the Gastroparesis Cardinal Symptom Index (GCSI), and quality of life was assessed using the Patient Assessment of Upper Gastrointestinal Disorders - Quality of Life scale and the Gastrointestinal Quality of Life Index scores. Gastric emptying was measured using 4-hour scintigraphy before G-POEM and at 3 months.
Feasibility of the procedure was 100 %. Compared with baseline values, G-POEM significantly improved symptoms (GCSI: 1.3 vs. 3.5; < 0.001), quality of life, and gastric emptying (T½: 100 vs. 345 minutes, < 0.001; %H2: 56.0 % vs. 81.5 %, < 0.001; %H4: 15.0 % vs. 57.5 %, = 0.003) at 3 months. The clinical success of G-POEM using the functional imaging probe inflated to 50 mL had specificity of 100 % and sensitivity of 72.2 % ( = 0.04; 95 % confidence interval 0.51 - 0.94; area under the curve 0.72) at a distensibility threshold of 9.2 mm/mmHg.
G-POEM was efficacious and safe for treating refractory gastroparesis, especially in patients with low pyloric distensibility.
胃轻瘫是一种功能性疾病，其特征为存在多种症状，且存在胃排空延迟而无机械梗阻。最近一系列回顾性研究表明，经口内镜下幽门肌切开术（G-POEM）是一种有前途的内镜治疗方法，适用于治疗难治性胃轻瘫患者。本前瞻性研究旨在评估 G-POEM 的可行性、安全性和疗效。
前瞻性纳入 20 例难治性胃轻瘫患者（10 例糖尿病，10 例非糖尿病），使用内镜功能腔内成像探头评估幽门功能后，行 G-POEM 治疗。使用胃轻瘫卡特尔症状指数（GCSI）评估临床反应，使用患者对上消化道疾病的评估-生活质量量表和胃肠道生活质量指数评分评估生活质量。在 G-POEM 治疗前和 3 个月时使用 4 小时闪烁扫描法测量胃排空。
该操作的可行性为 100%。与基线值相比，G-POEM 显著改善了症状（GCSI：1.3 比 3.5；<0.001）、生活质量和胃排空（T½：100 比 345 分钟，<0.001；%H2：56.0%比 81.5%，<0.001；%H4：15.0%比 57.5%，=0.003），3 个月时。使用充气至 50ml 的功能成像探头进行 G-POEM 的临床成功率，在顺应性阈值为 9.2mm/mmHg 时，特异性为 100%，灵敏度为 72.2%（=0.04；95%置信区间 0.51-0.94；曲线下面积 0.72）。
G-POEM 治疗难治性胃轻瘫是有效且安全的，尤其是在幽门顺应性较低的患者中。
