Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA, USA.
Division of Gastroenterology and Hepatology, Shanghai Insititute of Digestive Disease, Renji Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200127, China.
Chin Med J (Engl). 2022 Jun 20;135(12):1432-1437. doi: 10.1097/CM9.0000000000002068.
Gastroparesis is a debilitating medical condition with limited treatment options. Gastric per-oral pyloromyotomy (G-POEM) has emerged as a promising treatment option with remarkable short-term clinical success shown in multiple studies. While the post-procedure protocol is not standardized across many centers, the majority of the centers observes these patients in the hospital after the procedure for monitoring. In this single-center prospective study, we evaluated the safety and feasibility of same day discharge after the G-POEM procedure.
All the patients with refractory gastroparesis undergoing G-POEM from October 2019 to March 2020 were enrolled. A total of 25 patients were enrolled in the procedure. Based on the pre-defined criteria, patients were either discharged on the same day after the procedure or admitted to the hospital for further observation. The patient and procedure-related data were extracted from the chart review. Univariate analysis was performed (chi-squared test) on categorical variables after organizing categorical variables as numeric counts or percentages. The student t test was performed on continuous variables after reporting as mean and standard deviation. For analysis with a smaller sample size, Fisher exact and Mann-Whitney tests were used.
A total of 25 patients were enrolled. The technical success of G-POEM was 100% and clinical success was 80% (20/25) at 1-month follow-up. Of the 25 patients, 9 patients (36%) were discharged on the same day according to the procedure from the recovery unit. Of the remaining 16 patients who were admitted to the hospital post-procedure, 10 (40%) were admitted due to procedure-related causes while other admissions were either pre-planned or due to social reasons. The average Charlson comorbidity index was lower in the same day discharge group ( P < 0.05). The number of patients requiring double myotomy was higher in the same day discharge group ( P < 0.05). The overall complication rate of G-POEM in the study cohort was 12% (3/25) with all complications being mild without any severe adverse events.
G-POEM is a safe and effective method of treatment for refractory GP with higher clinical success in short-term follow-up. The same day discharge after G-POEM is safe and feasible in >50% of patients with close periprocedural monitoring.
胃轻瘫是一种使人虚弱的医疗状况，治疗选择有限。胃经口幽门肌切开术（G-POEM）已成为一种有前途的治疗选择，多项研究显示其短期临床成功率显著。虽然许多中心的术后方案没有标准化，但大多数中心在手术后会在医院观察这些患者以进行监测。在这项单中心前瞻性研究中，我们评估了 G-POEM 手术后当天出院的安全性和可行性。
所有 2019 年 10 月至 2020 年 3 月期间接受 G-POEM 治疗的难治性胃轻瘫患者均被纳入研究。共有 25 例患者接受了该手术。根据预先确定的标准，患者要么在手术后当天出院，要么住院进一步观察。从病历回顾中提取患者和手术相关数据。对分类变量进行单变量分析（卡方检验），将分类变量组织为数字计数或百分比。对连续变量进行学生 t 检验，报告为平均值和标准差。对于样本量较小的分析，使用 Fisher 精确检验和 Mann-Whitney 检验。
共纳入 25 例患者。G-POEM 的技术成功率为 100%，25 例患者中有 20 例（80%）在 1 个月随访时取得临床成功。在 25 例患者中，根据恢复单元的程序，有 9 例（36%）患者当天出院。在其余 16 例住院的患者中，10 例（40%）因手术相关原因住院，其他住院是预先计划的或因社会原因。当天出院组的平均 Charlson 合并症指数较低（P<0.05）。当天出院组需要双肌切开术的患者人数较多（P<0.05）。研究队列中 G-POEM 的总体并发症发生率为 12%（3/25），所有并发症均为轻度，无严重不良事件。
G-POEM 是治疗难治性 GP 的一种安全有效的方法，在短期随访中具有更高的临床成功率。在密切围手术期监测下，>50%的患者可安全且可行地当天出院。
