Yan Jin, Tan Yuyong, Zhou Bingyi, Zhang Shilan, Wang Xuehong, Liu Deliang
Gastroenterology, The Second Xiangya Hospital. Central South University, China.
Rev Esp Enferm Dig. 2020 Mar;112(3):219-228. doi: 10.17235/reed.2020.6559/2019.
to evaluate the efficacy and safety of gastric per-oral endoscopic myotomy (G-POEM) for the treatment of refractory gastroparesis.
PubMed, Embase and Cochrane databases were searched and used for study inclusion. Clinical studies since January 2013 to October 2019 were identified as suitable for inclusion. Conference papers, review articles, case reports, animal studies, letters, studies with repetitive data, studies that did not mention the Gastroparesis Cardinal Symptom Index (GCSI) score/gastric emptying scintigraphy (GES) hours or were not indicated in the standard form were excluded. GCSI score, GCSI reduction, gastric emptying scintigraphy at four hours (GES-4h) and GES time (GET) reduction were considered as major indexes and the meta-analysis was achieved using Review Manager 5.3. Research bias was measured according to Cochrane handbook.
nine studies were included with a total of 235 patients that underwent G-POEM, and the technical success rate was 100%. After G-POEM, patients reported changes in GCSI score (6/9 studies, mean difference 1.41 [CI: 0.93, 1.88], p < 0.0001), GCSI reduction (8/9 studies, odds ratio 3.00 [CI: 2.24, 4.03], p < 0.0001), GES-4h (8/9 studies, mean difference 23.78 [CI: 19.88, 27.68], p < 0.00001) and GET reduction (6/9 studies, odds ratio 3.50 [CI: 2.12, 5.78], p < 0.00001). The intra-procedure complication rate was 5.1% (12/235), including capnoperitoneum (seven cases) and accidental mucotomy (five cases). The post-procedure complication rate was 6.8% (16/235), including abdominal pain (three cases), bleeding (three cases), ulcer (one case), difficulty swallowing (one case) and others (eight cases). Both per- and post-procedure complications were easily managed by conservative or endoscopic treatments.
the results show that gastroparesis patients can benefit from G-POEM, the success rate was impressive and the complication rate was relatively low. However, caution is necessary when interpreting the results, primarily due to the limitations of uncontrolled studies. Randomized control studies are still needed for further evaluations.
评估经口内镜下胃肌切开术（G-POEM）治疗难治性胃轻瘫的疗效和安全性。
检索PubMed、Embase和Cochrane数据库并用于纳入研究。确定2013年1月至2019年10月期间的临床研究适合纳入。排除会议论文、综述文章、病例报告、动物研究、信函、有重复数据的研究、未提及胃轻瘫主要症状指数（GCSI）评分/胃排空闪烁扫描（GES）小时数或未按标准格式注明的研究。将GCSI评分、GCSI降低值、4小时胃排空闪烁扫描（GES-4h）和GES时间（GET）降低值作为主要指标，并使用Review Manager 5.3进行荟萃分析。根据Cochrane手册测量研究偏倚。
纳入9项研究，共235例接受G-POEM治疗的患者，技术成功率为100%。G-POEM术后，患者的GCSI评分（6/9项研究，平均差值1.41[CI：0.93，1.88]，p<0.0001）、GCSI降低值（8/9项研究，比值比3.00[CI：2.24，4.03]，p<0.0001）、GES-4h（8/9项研究，平均差值23.78[CI：19.88，27.68]，p<0.00001）和GET降低值（6/9项研究，比值比3.50[CI：2.12，5.78]，p<0.00001）均有变化。术中并发症发生率为5.1%（12/235），包括气腹（7例）和意外黏膜切开（5例）。术后并发症发生率为6.8%（16/235），包括腹痛（3例）、出血（3例）、溃疡（1例）、吞咽困难（1例）和其他（8例）。术中及术后并发症均易于通过保守或内镜治疗处理。
结果表明胃轻瘫患者可从G-POEM中获益，成功率令人印象深刻，并发症发生率相对较低。然而，在解释结果时需要谨慎，主要是由于非对照研究的局限性。仍需要进行随机对照研究以作进一步评估。
