Ichkhanian Yervant, Hwang Joo Ha, Ofosu Andrew, Li Andrew A, Szvarca Daniel, Draganov Peter V, Yang Dennis, Alsheik Eva, Zuchelli Tobias, Piraka Cyrus, Mony Shruti, Khashab Mouen A
Henry Ford Health System, Department of Internal Medicine, Detroit, Michigan, United States.
Divisions of Gastroenterology and Hepatology, Stanford University, School of Medicine, Stanford, California, United States.
Endosc Int Open. 2022 Jun 10;10(6):E832-E839. doi: 10.1055/a-1797-9587. eCollection 2022 Jun.
Gastroparesis post-lung transplant (LTx) can lead to increased risk of gastroesophageal reflux (GER) and accelerated graft dysfunction. We aimed to evaluate the efficacy and safety of gastric per-oral endoscopic myotomy (G-POEM), a promising tool in patients with refractory gastroparesis, for managing refractory gastroparesis and GER in post-LTx patients. This was a multicenter retrospective study on post-LTx patients who underwent G-POEM for management of gastroparesis and GER that were refractory to standard medical therapy. The primary outcome was clinical success post-G-POEM. Secondary outcomes included the rate of post-G-POEM objective esophageal pH exam normalization, rate of gastric emptying scintigraphy (GES) normalization, technical success, and adverse events. A total of 20 patients (mean age 54.7 ± 14.1 years, Female 50 %) underwent G-POEM at a median time of 13 months (interquartile range 6.5-13.5) post-LTx. All G-POEM procedures were technically successful. Clinical success was achieved in 17 (85 %) patients during a median follow-up time of 8.9 (IQR: 3-17) months post-G-POEM. Overall GCSI and two of its subscales (bloating and postprandial fullness/early satiety) improved significantly following G-POEM. Two patients (10 %) developed post-procedural AEs (delayed bleeding 1, pyloric stenosis 1, both moderate in severity). Post-G-POEM GES improvement was achieved in 12 of 16 patients (75 %). All 20 patients were on proton pump inhibitors pre-G-POEM, as opposed to five post-G-POEM. Post-G-POEM PH study normalization was noted in nine of 10 patients (90 %) who underwent both pre- and post-G-poem pH testing. G-POEM is a promising noninvasive therapeutic tool for management of refractory gastroparesis and GER post-LTx.
肺移植（LTx）后胃轻瘫可导致胃食管反流（GER）风险增加和移植功能加速衰退。我们旨在评估经口内镜下胃肌切开术（G-POEM）这一用于难治性胃轻瘫患者的有前景的工具，在管理肺移植术后难治性胃轻瘫和GER方面的疗效和安全性。这是一项针对因胃轻瘫和GER接受G-POEM治疗且对标准药物治疗无效的肺移植术后患者的多中心回顾性研究。主要结局是G-POEM术后的临床成功。次要结局包括G-POEM术后食管pH值客观检查正常化率、胃排空闪烁扫描（GES）正常化率、技术成功率和不良事件。共有20例患者（平均年龄54.7±14.1岁，女性占50%）在肺移植术后中位时间13个月（四分位间距6.5 - 13.5）接受了G-POEM。所有G-POEM手术在技术上均获成功。在G-POEM术后中位随访时间8.9（四分位间距：3 - 17）个月期间，17例（85%）患者取得了临床成功。总体胃肠道症状评分指数（GCSI）及其两个子量表（腹胀和餐后饱胀/早饱）在G-POEM术后显著改善。2例患者（10%）发生了术后不良事件（延迟出血1例，幽门狭窄1例，均为中度严重程度）。16例患者中有12例（75%）在G-POEM术后GES得到改善。所有20例患者在G-POEM术前均使用质子泵抑制剂，而术后为5例。在接受G-POEM术前和术后pH值检测的10例患者中，9例（90%）在G-POEM术后pH值研究正常化。G-POEM是管理肺移植术后难治性胃轻瘫和GER的一种有前景的非侵入性治疗工具。
