Section of Surgical Endoscopy, Department of General Surgery Cleveland Clinic, Cleveland, OH.
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH.
Ann Surg. 2018 Sep;268(3):421-430. doi: 10.1097/SLA.0000000000002927.
For patients with gastroparesis, temporary pyloric disruption has been shown to improve symptoms and gastric emptying. Per-oral pyloromyotomy (POP) is an innovative endoscopic procedure to divide the pylorus from within a submucosal tunnel, as a corollary to surgical pyloromyotomy. Here we evaluate subjective and objective outcomes 12-weeks after POP at a high volume center.
The first 100 consecutive patients undergoing POP were included, with procedure dates between January 2016 and October 2017. Patients were evaluated using the Gastroparesis Cardinal Symptom Index (GCSI), and 4-hour solid-phase scintigraphic gastric emptying studies (GES) prior to procedure and at 90 days post-POP RESULTS:: The study cohort was 85% female with a mean age of 45.0 ± 14.6 years. Gastroparesis etiologies were divided among idiopathic (56%), diabetic (21%), postsurgical (19%), and other in 4%. There were 67% of the patients who had previous endoscopic or surgical interventions for gastroparesis. Most POP procedures were performed in the operating room (97%) and were completed in an average of 33 minutes. Ten patients incurred complications (10%), which included 1 diagnostic laparoscopy and 2 cases of gastrointestinal bleeding. Overall GCSI improved from a preoperative mean of 3.82 ± 0.86 to 2.54 ± 1.2 (P < 0.001). The improvement in each GCSI subscore was also highly statistically significant. Among the patients with postoperative GES available, 78% had objectively better 4-hour emptying with a mean improvement in retention by 23.6% (P < 0.001). This included 57% of patients with normal gastric emptying post-POP.
For patients with medically refractory gastroparesis, POP results in both subjective and objective improvement in the majority of patients. Prior intervention does not obviate POP as a therapeutic option. POP should be included along the treatment algorithm for patients with gastroparesis as an organ-sparing procedure.
对于胃轻瘫患者，暂时破坏幽门已被证明可以改善症状和胃排空。经口幽门肌切开术（POP）是一种创新的内镜手术，通过黏膜下隧道从内部分割幽门，作为外科幽门肌切开术的推论。在这里，我们在一个高容量中心评估了 POP 后 12 周的主观和客观结果。
纳入了 2016 年 1 月至 2017 年 10 月期间进行 POP 的前 100 例连续患者。在术前和 POP 后 90 天，使用胃轻瘫卡特尔症状指数（GCSI）和 4 小时固相闪烁胃排空研究（GES）对患者进行评估。
研究队列中 85%为女性，平均年龄为 45.0±14.6 岁。胃轻瘫的病因分为特发性（56%）、糖尿病（21%）、手术后（19%）和其他（4%）。有 67%的患者曾因胃轻瘫接受过内镜或手术干预。大多数 POP 手术在手术室进行（97%），平均耗时 33 分钟。有 10 名患者发生并发症（10%），包括 1 例诊断性腹腔镜检查和 2 例胃肠道出血。总体 GCSI 从术前的 3.82±0.86 改善至 2.54±1.2（P<0.001）。每个 GCSI 子评分的改善也具有高度统计学意义。在术后 GES 可用的患者中，78%的患者 4 小时排空有客观改善，平均潴留减少 23.6%（P<0.001）。这包括 57%的患者在 POP 后胃排空正常。
对于药物难治性胃轻瘫患者，POP 可使大多数患者的主观和客观症状均得到改善。既往干预并不能排除 POP 作为一种治疗选择。POP 应作为一种保留器官的手术，被纳入胃轻瘫的治疗方案中。
