Division of Gastroenterology, University of California-San Francisco, San Francisco, California, USA.
Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Aliment Pharmacol Ther. 2022 Jan;55(2):168-177. doi: 10.1111/apt.16725. Epub 2021 Dec 1.
Several studies have examined the efficacy of gastric peroral endoscopic myotomy (G-POEM) for gastroparesis.
To evaluate the mid-term efficacy of G-POEM by meta-analysis of studies with a minimum 1 year of follow-up.
We reviewed several databases from inception to 10 June 2021 to identify studies that evaluated the efficacy of G-POEM in refractory gastroparesis, and had at least 1 year of follow-up. Our outcomes of interest were clinical success at 1 year, adverse events, difference in mean pre- and 1 year post-procedure Gastroparesis Cardinal Symptom Index (GCSI) score, and difference in mean pre- and post-procedure EndoFLIP measurements. We analysed data using a random-effects model and assessed heterogeneity by I statistic.
We included 10 studies comprising 482 patients. Pooled rates (95% CI) of clinical success at 1 year and adverse events were 61% (49%, 71%) and 8% (6%, 11%), respectively. Mean GCSI at 1 year post-procedure was significantly lower than pre-procedure; mean difference (MD) (95% CI) -1.4 (-1.9, -0.9). Mean post-procedure distensibility index was significantly higher than pre-procedure in the clinical success group at 40 and 50 mL volume distension; standardised mean difference (95% CI) 0.82 (0.07, 1.64) and 0.91 (0.32, 1.49), respectively. In the clinical failure group, there was no significant difference between mean pre- and post-procedure EndoFLIP measurements.
G-POEM is associated with modest clinical success at 1 year. Additional studies with longer follow-up are required to evaluate its longer-term efficacy.
多项研究已经评估了经口内镜下肌切开术（G-POEM）治疗胃轻瘫的疗效。
通过对至少 1 年随访的研究进行荟萃分析，评估 G-POEM 的中期疗效。
我们检索了多个数据库，从建库到 2021 年 6 月 10 日，以确定评估难治性胃轻瘫患者 G-POEM 疗效且随访时间至少 1 年的研究。我们感兴趣的结局指标为 1 年时的临床成功率、不良事件、术前和 1 年时胃轻瘫综合症状评分（GCSI）的平均差值，以及术前和术后 EndoFLIP 测量的平均差值。我们使用随机效应模型分析数据，并通过 I ²统计量评估异质性。
我们纳入了 10 项研究，共纳入 482 例患者。1 年时的临床成功率（95%CI）和不良事件发生率分别为 61%（49%，71%）和 8%（6%，11%）。术后 1 年时 GCSI 评分显著低于术前，平均差值（MD）（95%CI）为-1.4（-1.9，-0.9）。在临床成功组中，以 40 和 50mL 容量扩张时，术后扩张指数显著高于术前，标准化均数差（95%CI）分别为 0.82（0.07，1.64）和 0.91（0.32，1.49）。在临床失败组中，术后和术前的 EndoFLIP 测量值之间无显著差异。
G-POEM 治疗胃轻瘫 1 年时的临床效果尚可。需要更多长期随访的研究来评估其长期疗效。
