Kolb Jennifer M, Sowa Piotr, Samarasena Jason, Chang Kenneth J
Division of Gastroenterology, Digestive Health Institute, University of California Irvine, Irvine, California, USA.
VideoGIE. 2021 Oct 27;7(2):82-84. doi: 10.1016/j.vgie.2021.09.010. eCollection 2022 Feb.
Gastric peroral endoscopic pyloromyotomy (G-POEM) is emerging as a treatment option for patients with gastroparesis. The most technically difficult part of the procedure is creating a submucosal tunnel in the gastric antrum, which can be directionally challenging. We describe a novel navigational tunneling method that guides submucosal dissection in the direction of the pylorus and helps to identify the pyloric landmarks.
Consecutive patients from September to December 2020 who underwent G-POEM for symptomatic gastroparesis were included. All cases were confirmed by prolonged gastric emptying study. The navigational tunnel technique was performed as follows: (1) mucosal cautery markings were made to outline the tunnel starting 3 to 4 cm proximal to the pylorus, (2) submucosal injection was done at the level of the pylorus and extended backward to the incision point, and (3) submucosal dissection was carried out after the prior submucosal injection straight to the pylorus.
Six patients with gastroparesis underwent G-POEM with the navigational tunneling technique. The average time for submucosal injection was 2 minutes and 42 seconds, and the average tunnel time was 15 minutes and 36 seconds. There were no adverse events. All patients reported significant improvement (50%-85%) in symptoms.
This novel navigational tunneling technique appears to guide and facilitate G-POEM by providing a visual path for submucosal dissection straight to the pylorus. It may increase efficiency, decreasing the need to repeatedly exit the tunnel to check direction and preventing nonproductive wandering. It may also help identify the pyloric ring within the tunnel.
经口内镜下幽门肌切开术（G-POEM）正逐渐成为胃轻瘫患者的一种治疗选择。该手术技术上最困难的部分是在胃窦部创建一个黏膜下隧道，这在方向上具有挑战性。我们描述了一种新型的导航隧道技术，该技术可引导黏膜下剥离朝着幽门方向进行，并有助于识别幽门标志。
纳入2020年9月至12月因症状性胃轻瘫接受G-POEM治疗的连续患者。所有病例均经延长胃排空研究证实。导航隧道技术操作如下：（1）在距幽门近端3至4厘米处进行黏膜烧灼标记以勾勒隧道起点，（2）在幽门水平进行黏膜下注射并向后延伸至切口点，（3）在先前黏膜下注射后直接朝着幽门进行黏膜下剥离。
6例胃轻瘫患者采用导航隧道技术接受了G-POEM治疗。黏膜下注射的平均时间为2分42秒，平均隧道创建时间为15分36秒。无不良事件发生。所有患者均报告症状有显著改善（50%-85%）。
这种新型的导航隧道技术似乎通过为直接通向幽门的黏膜下剥离提供一条可视化路径来引导和促进G-POEM。它可能会提高效率，减少反复退出隧道检查方向的必要性，并防止无效的盲目操作。它还可能有助于在隧道内识别幽门环。
