Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA.
Department of Hospital Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
J Gastrointest Surg. 2020 Jun;24(6):1417-1420. doi: 10.1007/s11605-020-04558-x. Epub 2020 Mar 12.
Gastric Per-oral Endoscopic pyloromyotomy (G-POEM) or per-oral pyloromyotomy (POP) is a novel procedure recently described for treatment of medically refractory gastroparesis; however, its efficacy and safety is not clear in patients with postsurgical gastroparesis (PsGP). We conducted a systematic review and meta-analysis to determine the efficacy and safety of G-POEM in PsGP. A total of 6 studies were included in the analysis. The pooled rate of success by gastroparesis cardinal symptom index (GCSI) and 4-h gastric emptying study (GES) were 89.6% (95% C.I. 72.7-96.5) and 81.5% (95% CI 47.8-95.5) respectively. There was a statistically significant improvement in GCSI score after 3 months of G-POEM as compared with pre G-POEM GCSI scores (2.7 (95% C.I. 0-5.5) vs 8.2 (95% C.I. 5.4-11) (p = 0.007). The mean pre G-POEM 4 h GES was 93.8% (95% C.I. 42.3-145.3) with improvement in post G-POEM GES to 44.5% (95% C.I. 0-95)(p = 0.2). The pooled rate of total adverse events was 9% (95% C.I. 2.7-25.9). Our study showed a good clinical success of G-POEM in PsGP patients along with significant improvement in 3-month GCSI scores. There was an improvement of GES after G-POEM, but it did not reach statistical significance. In conclusion, G-POEM is an effective and safe treatment option for PsGP.
胃经口内镜下幽门肌切开术（G-POEM）或经口幽门肌切开术（POP）是最近为治疗药物难治性胃轻瘫而描述的一种新方法；然而，其在术后胃轻瘫（PsGP）患者中的疗效和安全性尚不清楚。我们进行了系统评价和荟萃分析，以确定 G-POEM 在 PsGP 中的疗效和安全性。共有 6 项研究纳入分析。根据胃轻瘫 cardinal 症状指数（GCSI）和 4 小时胃排空研究（GES）的综合成功率分别为 89.6%（95%可信区间 72.7-96.5）和 81.5%（95%可信区间 47.8-95.5）。与 G-POEM 前的 GCSI 评分相比，G-POEM 后 3 个月的 GCSI 评分有统计学显著改善（2.7（95%可信区间 0-5.5）与 8.2（95%可信区间 5.4-11）（p=0.007）。G-POEM 前 4 小时 GES 的平均为 93.8%（95%可信区间 42.3-145.3），G-POEM 后 GES 改善至 44.5%（95%可信区间 0-95）（p=0.2）。总的不良事件发生率为 9%（95%可信区间 2.7-25.9）。我们的研究表明，G-POEM 在 PsGP 患者中具有良好的临床疗效，并且在 3 个月时 GCSI 评分显著改善。G-POEM 后 GES 有所改善，但未达到统计学意义。总之，G-POEM 是治疗 PsGP 的有效且安全的治疗选择。
