Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center and Humanitas University, Rozzano, Italy.
Division of Gastroenterology and Hepatology, University of Kansas School of Medicine, Kansas City, Kansas, USA; Division of Gastroenterology and Hepatology, Veteran Affairs Medical Center, Kansas City, Missouri, USA.
Gastrointest Endosc. 2020 Apr;91(4):746-752.e5. doi: 10.1016/j.gie.2019.11.039. Epub 2019 Dec 3.
Gastroparesis (GP) is a chronic debilitating condition. Prior pyloric-targeted procedures are either invasive or have questionable efficacy. Gastric peroral pyloromyotomy (G-POEM) has been proposed as a minimally invasive approach. We performed a pooled analysis to evaluate the efficacy and safety of G-POEM for GP.
Electronic databases (Medline, Scopus, EMBASE) were searched up to January 2019. Studies including patients who underwent G-POEM for GP were eligible. Procedural, clinical, and safety outcomes were assessed by pooling data with a random- or fixed-effect model according to the degree of heterogeneity to obtain a proportion with a 95% confidence interval.
Ten studies were eligible for inclusion (292 patients), and 2 of the 10 studies were prospective. Seven studies were performed in the United States, 2 in France, and 1 in China. Endoscopic pyloromyotomy was feasible in all patients. Significant symptomatic improvement was achieved after 83.9% of procedures (mean follow-up, 7.8 ± 5.5 months). When comparing the mean values of pre- and postprocedural scintigraphic evolution, there was a significant decrease of the residual percentage at 2 and 4 hours. The overall adverse events rate was 6.8%.
G-POEM appears to be a promising approach for GP in terms of safety and efficacy outcomes in the short term.
胃轻瘫（GP）是一种慢性衰弱性疾病。先前针对幽门的手术方法要么具有侵入性，要么疗效存在疑问。胃经口幽门肌切开术（G-POEM）已被提议作为一种微创方法。我们进行了一项汇总分析，以评估 G-POEM 治疗 GP 的疗效和安全性。
检索了电子数据库（Medline、Scopus、EMBASE），检索截至 2019 年 1 月。纳入接受 G-POEM 治疗 GP 的患者的研究符合条件。通过随机或固定效应模型汇总数据，根据异质性程度评估手术、临床和安全性结局，以获得 95%置信区间的比例。
有 10 项研究符合纳入条件（292 名患者），其中 2 项研究为前瞻性研究。7 项研究在美国进行，2 项在法国进行，1 项在中国进行。所有患者均可进行内镜下幽门肌切开术。83.9%的患者在手术后症状明显改善（平均随访时间 7.8±5.5 个月）。比较放射性核素扫描前后的平均值，2 小时和 4 小时的残留百分比有显著下降。总的不良事件发生率为 6.8%。
就短期安全性和疗效结果而言，G-POEM 似乎是治疗 GP 的一种有前途的方法。
