Dolan Russell D, McCarty Thomas R, Bazarbashi Ahmad Najdat, Thompson Christopher C
Division of Gastroenterology, Hepatology and Endoscopy. Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Houston Methodist Hospital, Lynda K. and David M. Underwood Center for Digestive Disorders, Houston, TXWeill Cornell Medical College, New York, NYTexas A&M University School of Medicine, Bryan College Station, TX.
J Clin Gastroenterol. 2025 Apr 1;59(4):325-334. doi: 10.1097/MCG.0000000000002010.
Gastric per-oral endoscopic myotomy (G-POEM) is an innovative treatment that has become increasingly utilized for patients with refractory gastroparesis. The aim of this systematic review and meta-analysis was to evaluate the safety and effectiveness of G-POEM for the treatment of gastroparesis.
Individualized search strategies were developed through February 2021 in accordance with the PRISMA and MOOSE guidelines. This meta-analysis was performed by calculating pooled proportions and mean difference preprocedure and postprocedure with rates estimated using random effects models. Measured outcomes included technical success, clinical success, improvement in gastroparesis cardinal symptom index (GCSI), change in gastric emptying rate, alterations in impedance planimetry (functional lumen imaging probe [FLIP]) assessment, and adverse events.
A total of 20 studies (n=797 patients; 67.41% female) were included. The mean age was 48.92±11.61 y, with an average duration of 4.24±1.11 y since gastroparesis diagnosis. Technical success was 98.47% [(95% CI: 97.14, 99.19); I2 =0.00] with a mean myotomy length of 3.78±1.16 cm. In terms of clinical success, mean preprocedure GCSI scores were 3.38±0.37 and improved significantly postprocedure [weighted mean difference -1.56 (95% CI: -1.89 to -1.24); I2 =82.53; P <0.001]. Gastric retention after 4 hours demonstrated ~50% improvement (preprocedure 43.08±9.24% versus postprocedure 22.97±10.19%; P <0.001). FLIP assessment with 40 mL and 50 mL balloons demonstrated a significant increase in diameter, distensibility index, and cross-sectional area postprocedure (all P <0.05). Procedure-associated adverse events occurred among 10.92% [(95% CI 5.09 to 19.32); I2 =82.85] of patients.
G-POEM appears safe and highly effective for the treatment of patients with refractory gastroparesis regardless of symptom predominance or etiology.
经口内镜下胃肌切开术（G-POEM）是一种创新治疗方法，越来越多地应用于难治性胃轻瘫患者。本系统评价和荟萃分析的目的是评估G-POEM治疗胃轻瘫的安全性和有效性。
根据PRISMA和MOOSE指南，制定了截至2021年2月的个性化检索策略。本荟萃分析通过计算术前和术后的合并比例以及平均差值进行，采用随机效应模型估计率。测量的结果包括技术成功率、临床成功率、胃轻瘫主要症状指数（GCSI）的改善、胃排空率的变化、阻抗平面测量（功能性管腔成像探头[FLIP]）评估的改变以及不良事件。
共纳入20项研究（n = 797例患者；67.41%为女性）。平均年龄为48.92±11.61岁，自胃轻瘫诊断以来的平均病程为4.24±1.11年。技术成功率为98.47%[（95%CI：97.14，99.19）；I2 = 0.00]，平均肌切开长度为3.78±1.16 cm。在临床成功率方面，术前GCSI平均评分为3.38±0.37，术后显著改善[加权平均差值 -1.56（95%CI：-1.89至-1.24）；I2 = 82.53；P < 0.001]。4小时后的胃潴留显示改善约50%（术前43.08±9.24%对术后22.97±10.19%；P < 0.001）。使用40 mL和50 mL球囊进行的FLIP评估显示术后直径、扩张性指数和横截面积显著增加（均P < 0.05）。10.92%[（95%CI 5.09至19.32）；I2 = 82.85]的患者发生了与手术相关的不良事件。
无论症状优势或病因如何，G-POEM治疗难治性胃轻瘫患者似乎安全且高效。
