胃经口内镜肌切开术（G-POEM）治疗难治性胃瘫的疗效和安全性：3 年随访结果。
Efficacy and safety of gastric peroral endoscopic myotomy (G-POEM) for refractory gastroparesis: 3-year follow up results.
机构信息
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Ultrasonography and Endoscopy Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan; College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
出版信息
J Formos Med Assoc. 2022 Jul;121(7):1334-1341. doi: 10.1016/j.jfma.2021.08.029. Epub 2021 Oct 19.
BACKGROUND/PURPOSE: Gastroparesis is a common but easily overlooked disease. Gastric peroral endoscopic myotomy (G-POEM) is one of the third-space endoscopy techniques to treat gastroparesis. In this study, we aimed to evaluate the efficacy and safety of G-POEM for patients with refractory gastroparesis.
METHODS
Between December 2017 and 2020, we consecutively enrolled patients with gastroparesis who failed after the administration of several kinds of medication and repeated admission for nutritional support. All patients underwent gastric emptying scintigraphy and answered a questionnaire on Gastroparesis Cardinal Symptom Index (GCSI). Demographic data, endoscopic procedure, and post procedural outcome were analyzed.
RESULTS
A total of 11 (9 women and 2 men) patients with refractory gastroparesis (nine with diabetes mellitus, one systemic lupus erythematosus, and one idiopathic) were enrolled. The mean (±standard deviation (SD)) procedure time was 61.82 (±18.99) min with technical and clinical success rates of 100% and 81.82%, respectively. A statistically significant improvement was observed in the clinical severity (mean GCSI score 36.00 vs. 14.73, p < 0.0001) and gastric emptying time (mean T 341.92 vs. 65.92 min, p = 0.016) after G-POEM. Hospital stay was 7.18 (±4.49) days without mortality. Complications included 4 (36.36%) patients with self-limited postprocedural abdominal pain and 3 (27.27%) patients with intra-procedural pneumoperitoneum. During the mean follow-up period of 554.36 days, one (9.09%) patient had relapsed clinical symptoms after 6 months.
CONCLUSION
G-POEM is an efficient and safe pylorus-directed endoscopic therapy for refractory gastroparesis with promising results.
背景/目的：胃轻瘫是一种常见但容易被忽视的疾病。胃经口内镜肌切开术（G-POEM）是治疗胃轻瘫的第三空间内镜技术之一。在本研究中，我们旨在评估 G-POEM 治疗难治性胃轻瘫的疗效和安全性。
方法
2017 年 12 月至 2020 年期间，我们连续纳入了几种药物治疗后失败且反复入院进行营养支持的难治性胃轻瘫患者。所有患者均行胃排空闪烁显像检查，并回答胃轻瘫卡特尔症状指数（GCSI）问卷。分析人口统计学数据、内镜手术过程和术后结果。
结果
共纳入 11 例（9 名女性和 2 名男性）难治性胃轻瘫患者（9 例糖尿病、1 例系统性红斑狼疮、1 例特发性）。平均（±标准差（SD））手术时间为 61.82（±18.99）min，技术成功率和临床成功率分别为 100%和 81.82%。G-POEM 后临床严重程度（平均 GCSI 评分 36.00 与 14.73，p<0.0001）和胃排空时间（平均 T 341.92 与 65.92min，p=0.016）均有显著改善。G-POEM 后住院时间为 7.18（±4.49）天，无死亡病例。并发症包括 4 例（36.36%）患者出现自限性术后腹痛和 3 例（27.27%）患者出现术中气腹。在平均 554.36 天的随访期间，1 例（9.09%）患者在 6 个月后出现临床症状复发。
结论
G-POEM 是一种有效且安全的针对难治性胃轻瘫的幽门导向内镜治疗方法，具有良好的效果。
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