Department of Thoracic Surgery, The First Hospital of China Medical University, No.155 North Nanjing Street, Shenyang, 110001, People's Republic of China.
Department of Colorectal Surgery, Liaoning Cancer Hospital and Institute, Cancer Hospital of China Medical University, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, People's Republic of China.
J Gastrointest Surg. 2021 May;25(5):1108-1116. doi: 10.1007/s11605-020-04520-x. Epub 2020 May 11.
The emerging gastric per-oral endoscopic myotomy (G-POEM) is becoming an alternative treatment method for gastroparesis. This study aimed to evaluate the feasibility and safety of G-POEM for gastroparesis.
Relevant publications were identified through searching PubMed, EMBASE, Cochrane Library, and Web of Science before April 1, 2019. Studies presenting the clinical data of G-POEM for the treatment of gastroparesis were included. Data about effectiveness and safety were extracted, pooled, and analyzed. Forest plots were graphed based on random effects models.
A total of 272 patients representing 8 studies were eligible for analysis. The pooled rates of GCSI at preprocedure, 1-3 months, 6 months, and 12 months, were 3.25 (95% CI, 2.75-3.75), 1.80 (95% CI, 1.10-2.49), 1.56 (95% CI, 0.45-2.68), and 1.10 (95% CI, 0.75-1.45), respectively. The pooled results of 4-h GES pre- and post-G-POEM were 41.89% (95% CI, 32.75-51.03%) and 16.48% (95% CI, 9.83-23.14%), respectively. Furthermore, the pooled clinical response rate was 84% (95% CI, 77-89%). The GES improvement rate and GES normal rate were also analyzed, and the results were 84% (95% CI, 77-90%) and 53% (95% CI, 39-66%), respectively. Finally, the pooled adverse events rate was 12% (95% CI, 6-19%).
G-POEM was shown to be feasible and safe for the treatment of gastroparesis with various etiologies, which could be a potential first-line therapy for certain patients. Future studies are needed to investigate the appropriate patients for G-POEM to explore the "most beneficial" subgroup of patients.
新兴的经口内镜下胃肌切开术（G-POEM）正成为治疗胃轻瘫的一种替代治疗方法。本研究旨在评估 G-POEM 治疗胃轻瘫的可行性和安全性。
通过检索 PubMed、EMBASE、Cochrane 图书馆和 Web of Science，检索了截至 2019 年 4 月 1 日的相关文献。纳入了报告 G-POEM 治疗胃轻瘫的临床数据的研究。提取、汇总和分析有效性和安全性数据。基于随机效应模型绘制森林图。
共有 272 例患者（8 项研究）符合纳入标准。术前、术后 1-3 个月、6 个月和 12 个月的 GCSI 总有效率分别为 3.25（95% CI，2.75-3.75）、1.80（95% CI，1.10-2.49）、1.56（95% CI，0.45-2.68）和 1.10（95% CI，0.75-1.45）。术前和术后 4 小时 GES 的汇总结果分别为 41.89%（95% CI，32.75-51.03%）和 16.48%（95% CI，9.83-23.14%）。此外，临床总有效率为 84%（95% CI，77-89%）。GES 改善率和 GES 正常率分别为 84%（95% CI，77-90%）和 53%（95% CI，39-66%）。总的不良事件发生率为 12%（95% CI，6-19%）。
G-POEM 治疗各种病因的胃轻瘫是可行和安全的，可能成为某些患者的潜在一线治疗方法。未来需要研究合适的患者进行 G-POEM，以探索“最受益”的患者亚组。
