McCurdy Grace Ann, Gooden Tonia, Weis Francesca, Mubashir Maryam, Rashid Shazia, Raza Syed Musa, Morris James, Cai Qiang
Division of Gastroenterology and Hepatology, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
Division of Gastroenterology and Hepatology, Louisiana State University Health Sciences Center, 1501 Kings Highway, Suite 6-230, Shreveport, LA 71103-4228, USA.
Therap Adv Gastroenterol. 2023 Mar 26;16:17562848231151289. doi: 10.1177/17562848231151289. eCollection 2023.
Gastric peroral endoscopic pyloromyotomy (G-POEM or POP) is an endoscopic therapeutic modality for treatment of refractory gastroparesis. Since the first case reported in 2013, there are more than 200 papers published on G-POEM. In this narrative review, we summarize the short-term and long-term outcomes and review other important studies. The technical success rate is 100% and the short-term (within 1 year) success rate is about 50-80%. The procedure time is between 50 and 70 min while the average length of hospital stay was 2-3 days. The adverse event rate was around 10%. Few patients need further intervention. Three studies showed that at the 4-year follow-up, the response to G-POEM was durable, but there was a yearly recurrence rate of 13% or more. Redo G-POEM is feasible and can be of benefit for some patients. Most of the studies showed that long duration of illness is associated with poor outcomes. However, reliable predictors for successful outcomes are still unknown. Current literature indicates G-POEM is superior to gastric electric stimulator and surgical pyloroplasty. Endoflip has been used at G-POEM to predict the outcome, but the result is very preliminary. A recent sham study confirms the short-term efficacy of G-POEM. G-POEM is safe and about 50% of patients can be discharged to home on the same day. G-POEM allows for direct biopsy of the gastric muscle, which is the location of the pacemaker cells, the interstitial cells of Cajal; therefore, G-POEM may provide a new path for further research on the pathogenesis of gastroparesis.
经口内镜下幽门肌切开术（G-POEM或POP）是一种用于治疗难治性胃轻瘫的内镜治疗方法。自2013年首例病例报道以来，已有200多篇关于G-POEM的论文发表。在本叙述性综述中，我们总结了短期和长期疗效，并回顾了其他重要研究。技术成功率为100%，短期（1年内）成功率约为50%-80%。手术时间在50至70分钟之间，平均住院时间为2-3天。不良事件发生率约为10%。很少有患者需要进一步干预。三项研究表明，在4年的随访中，G-POEM的疗效持久，但每年的复发率为13%或更高。再次进行G-POEM是可行的，对一些患者有益。大多数研究表明，病程较长与预后不良有关。然而，成功预后的可靠预测因素仍然未知。当前文献表明G-POEM优于胃电刺激器和手术幽门成形术。Endoflip已用于G-POEM以预测结果，但结果非常初步。最近的一项假手术研究证实了G-POEM的短期疗效。G-POEM是安全的，约50%的患者可在同一天出院。G-POEM允许对胃肌进行直接活检，而胃肌是起搏细胞即Cajal间质细胞的所在位置；因此，G-POEM可能为胃轻瘫发病机制的进一步研究提供一条新途径。
