Shen Shanshan, Luo Hui, Vachaparambil Cicily, Mekaroonkamol Parit, Abdelfatah Mohamed M, Xu Guifang, Chen Huimin, Xia Liang, Shi Hong, Keilin Steve, Willingham Field, Christie Jennifer, Lin Edward, Cai Qiang
Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, United States.
Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
Endoscopy. 2020 May;52(5):349-358. doi: 10.1055/a-1111-8566. Epub 2020 Feb 21.
Gastric peroral endoscopic pyloromyotomy (G-POEM) and gastric electrical stimulation (GES) have been reported as treatment options for refractory gastroparesis. In this study, we compared the long term clinical outcomes of G-POEM versus GES in the treatment of such patients. METHODS : We retrospectively evaluated 111 consecutive patients with refractory gastroparesis between January 2009 and August 2018. To overcome selection bias, we used propensity score matching (1:1) between G-POEM and GES treatment. The primary outcome was the duration of clinical response. RESULTS : After propensity score matching, 23 patients were included in each group. After a median follow-up of 27.7 months, G-POEM had a significantly better and longer clinical response than GES (hazard ratio [HR] for clinical recurrence 0.39, 95 % confidence interval [CI] 0.16 - 0.95; = 0.04). The median duration of response was 25.4 months (95 %CI 8.7 - 42.0) in the GES group and was not reached in the G-POEM group. The Kaplan - Meier estimate of 24-month clinical response rate was 76.6 % with G-POEM vs. 53.7 % with GES. GES appeared to have little effect on idiopathic gastroparesis (HR for recurrence with G-POEM vs. GES 0.35, 95 %CI 0.13 - 0.95; = 0.05). The incidence of adverse events was higher in the GES group (26.1 % vs. 4.3 %; = 0.10). CONCLUSION : Among patients with refractory gastroparesis, clinical response was better and lasted longer with G-POEM than with GES. The positive outcomes with G-POEM are likely to derive from the superior clinical response in patients with idiopathic gastroparesis. Further studies are needed to confirm these findings.
经口内镜下幽门肌切开术（G-POEM）和胃电刺激（GES）已被报道为难治性胃轻瘫的治疗选择。在本研究中，我们比较了G-POEM与GES治疗此类患者的长期临床疗效。方法：我们回顾性评估了2009年1月至2018年8月期间连续的111例难治性胃轻瘫患者。为克服选择偏倚，我们在G-POEM和GES治疗之间采用倾向评分匹配（1:1）。主要结局是临床反应持续时间。结果：倾向评分匹配后，每组纳入23例患者。中位随访27.7个月后，G-POEM的临床反应明显优于GES且持续时间更长（临床复发风险比[HR]为0.39，95%置信区间[CI]为0.16 - 0.95；P = 0.04）。GES组的中位反应持续时间为25.4个月（95%CI为8.7 - 42.0），G-POEM组未达到。G-POEM的24个月临床反应率的Kaplan-Meier估计值为76.6%，而GES为53.7%。GES对特发性胃轻瘫似乎几乎没有影响（G-POEM与GES复发的HR为0.35，95%CI为0.13 - 0.95；P = 0.05）。GES组不良事件发生率更高（26.1%对4.3%；P = 0.10）。结论：在难治性胃轻瘫患者中，G-POEM的临床反应优于GES且持续时间更长。G-POEM的阳性结果可能源于特发性胃轻瘫患者更好的临床反应。需要进一步研究来证实这些发现。
