Conchillo José M, Straathof Jan Willem A, Mujagic Zlatan, Brouns Jenny H, Bouvy Nicole D, Keszthelyi Daniel, Masclee Ad A M
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
Department of Dietetics, Maastricht University Medical Centre, Maastricht, The Netherlands.
Endosc Int Open. 2021 Feb;9(2):E137-E144. doi: 10.1055/a-1311-0859. Epub 2021 Jan 25.
There are no reliable data to predict which patients with gastroparesis (GP) would benefit the most from gastric peroral endoscopic pyloromyotomy (G-POEM). The aim of the present study was to assess whether antro-duodenal motility patterns and pyloric distensibility can predict the outcome of G-POEM in patients with decompensated GP. In an open-label study, patients with GP and refractory symptoms were eligible for treatment with G-POEM if treatment attempts according to a standardized stepwise protocol had failed. Baseline assessment included Gastroparesis Cardinal Symptom Index (GCSI), C13-octanoic gastric emptying breath test and high-resolution antro-duodenal manometry. Pyloric distensibility using EndoFlip measurements was assessed at baseline and 3 months after the procedure. Explorative analyses were performed on potential predictors of response using logistic regression analyses. Twenty-four patients with decompensated GP underwent G-POEM. At baseline, 78.3 % and 61.9 % of patients showed antral hypomotility and neuropathic motor patterns, respectively. The technical success rate was 100 % (24/24). Mean GCSI improved significantly at 3, 6, and 12 months after G-POEM ( = 0.01). Median distensibility index (DI) improved significantly as compared with baseline (7.5 [6.9;11.7] vs. 5.3[3.1;8.1], = 0.004). A significant correlation was found between clinical response at 6 months and pyloric DI improvement ( = 0.003). No potential predictors of clinical response after G-POEM could be identified in an explorative analysis. G-POEM improved pyloric distensibility patterns in patients with decompensated GP. Clinical response at 6 months after G-POEM was associated with pyloric distensibility improvement. However, no potential predictors of response could be identified from either antro-duodenal motility patterns or pyloric distensibility.
目前尚无可靠数据来预测哪些胃轻瘫（GP）患者能从经口内镜下幽门肌切开术（G-POEM）中获益最大。本研究的目的是评估胃十二指肠动力模式和幽门扩张性是否能预测失代偿性GP患者G-POEM的治疗效果。在一项开放标签研究中，GP且症状难治的患者若按照标准化逐步方案进行治疗尝试失败，则有资格接受G-POEM治疗。基线评估包括胃轻瘫主要症状指数（GCSI）、C13-辛酸胃排空呼气试验和高分辨率胃十二指肠测压。使用EndoFlip测量的幽门扩张性在基线和术后3个月进行评估。使用逻辑回归分析对反应的潜在预测因素进行探索性分析。24例失代偿性GP患者接受了G-POEM治疗。基线时，分别有78.3%和61.9%的患者表现为胃窦动力低下和神经源性运动模式。技术成功率为100%（24/24）。G-POEM术后3、6和12个月时，平均GCSI显著改善（P = 0.01）。与基线相比，中位扩张性指数（DI）显著改善（7.5[6.9；11.7]对5.3[3.1；8.1]，P = 0.004）。发现6个月时的临床反应与幽门DI改善之间存在显著相关性（P = 0.003）。在探索性分析中未发现G-POEM术后临床反应的潜在预测因素。G-POEM改善了失代偿性GP患者的幽门扩张性模式。G-POEM术后6个月的临床反应与幽门扩张性改善相关。然而，从胃十二指肠动力模式或幽门扩张性中均未发现反应的潜在预测因素。
