Department of Surgery, University of Louisville, 550 S. Jackson St, 2nd floor, Louisville, KY, 40202, USA.
School of Public Health and Information Sciences, University of Louisville, Louisville, KY, USA.
Surg Endosc. 2023 Mar;37(3):2247-2252. doi: 10.1007/s00464-022-09437-x. Epub 2022 Jul 28.
Gastroparesis is characterized by delayed gastric emptying without a significant obstructive pathology and is estimated to effect more than 5 million adults in the United States. Therapies for this condition are divided into two categories: gastric electrical stimulation or pyloric therapies to facilitate gastric emptying. Pyloric procedures include pyloroplasty, a well-documented procedure, and per-oral endoscopic myotomy (POP), a relatively novel endoscopic procedure that disrupts the pyloric muscles endoscopically. There is a paucity of literature comparing the two procedures. The aim of this study is to compare the outcomes of these two techniques.
Under an IRB protocol, data were collected prospectively from September 2018 through April 2021 at our institution for patients undergoing POP (n = 63 patients) or robotic pyloroplasty (RP) (n = 48). Preoperative and postoperative data including sex, race, age, BMI, and Gastroparesis Cardinal Symptom Index (GCSI) score were analyzed using univariate and multivariate analysis.
There was no significant difference in sex, age, and BMI for both cohorts, but patients with RP were more likely to have private insurance, pre-op reflux, and PPI (p < .05 for all). Patients who underwent POP had significantly shorter operative time compared to RP (median 27 min vs 90, p < 0.001). The average change between preoperative and postoperative GCSI scores was significantly decreased for both interventions (POP mean = 8.2, RP 16.8, p < 0.001 both). However, comparing both data, RP has significantly better improvement in postoperative GCSI score than POP in both univariate (p < 0.001) and multivariate analysis (p = 0.030). This was reflected in the individual symptoms with nausea (p < 0.001), ability to finish meal (p = 0.037), abdomen visibly larger (p = 0.037) and bloating (p = 0.022) all showing improvement in both groups, but with RP having a more significant decrease in the scoring of these symptoms than POP. There was no significant difference in the number of postoperative complications (POP 19% vs RP 13%, p = 0.440).
Even though both interventions are significantly associated with improvement of symptoms in patients with gastroparesis, our data demonstrates that robotic pyloroplasty has a superior response in comparison to per-oral endoscopic myotomy for the management of these symptoms. Per-oral pyloromyotomy has a similar complication rate to robotic pyloroplasty with a shorter operative time.
胃轻瘫的特征是胃排空延迟，而没有明显的阻塞性病理，据估计，美国有超过 500 万成年人受其影响。这种疾病的治疗方法分为两类：胃电刺激或幽门治疗以促进胃排空。幽门术包括幽门成形术，这是一种经过充分证实的手术，以及经口内镜肌切开术（POP），这是一种相对较新的内镜手术，通过内镜破坏幽门肌肉。关于这两种手术的比较文献很少。本研究的目的是比较这两种技术的结果。
根据 IRB 方案，我们机构于 2018 年 9 月至 2021 年 4 月前瞻性地收集了接受 POP（n=63 例患者）或机器人幽门成形术（RP）（n=48 例）的患者的数据。使用单变量和多变量分析分析了包括性别、种族、年龄、BMI 和胃轻瘫关键症状指数（GCSI）评分在内的术前和术后数据。
两组患者的性别、年龄和 BMI 均无显著差异，但 RP 组患者更有可能拥有私人保险、术前反流和 PPI（p<0.05 均）。与 RP 相比，接受 POP 的患者的手术时间明显缩短（中位数 27 分钟比 90 分钟，p<0.001）。两种干预措施的术前和术后 GCSI 评分的平均变化均显著降低（POP 均值=8.2，RP 16.8，p<0.001 均）。然而，与 POP 相比，RP 在单变量（p<0.001）和多变量分析（p=0.030）中均具有更好的术后 GCSI 评分改善。这反映在个体症状上，包括恶心（p<0.001）、完成餐食的能力（p=0.037）、腹部明显增大（p=0.037）和腹胀（p=0.022），两组症状均有所改善，但 RP 组的这些症状评分下降幅度大于 POP 组。两组术后并发症的数量无显著差异（POP 19%比 RP 13%，p=0.440）。
尽管两种干预措施都与胃轻瘫患者的症状改善显著相关，但我们的数据表明，与经口内镜肌切开术相比，机器人幽门成形术在管理这些症状方面具有更好的反应。经口幽门肌切开术与机器人幽门成形术的并发症发生率相似，但手术时间更短。
