Department of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, the Netherlands.
Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven, the Netherlands.
Neurogastroenterol Motil. 2024 Oct;36(10):e14879. doi: 10.1111/nmo.14879. Epub 2024 Jul 26.
Gastric peroral endoscopic pyloromyotomy (G-POEM) is a promising therapeutic modality for refractory gastroparesis (GP). However, as characteristics of suitable patients for G-POEM remain unclear, antro-duodenal manometry (ADM) has been suggested to provide objective parameters for patient selection. The aim of the present study was to identify ADM parameters as predictors for treatment response after G-POEM in refractory GP.
Refractory GP patients who underwent a G-POEM between 2017 and 2022 were included. The following ADM parameters were mainly scored: antral hypomotility, pylorospasm, and the presence of neuropathic enteric patterns. Treatment response was defined as a GCSI-score decrease of ≥1 point 12 months after G-POEM. Explorative analyses were performed on potential predictors of response using logistic regression analysis.
Sixty patients (52 women, mean age 52 ± 14 years.) with refractory GP (33 idiopathic, 16 diabetic, 11 postsurgical) were included. Clinical response data were available for 52 patients. In 8 out of 60 patients, it was not feasible to advance the catheter beyond the pylorus. Abnormal ADM was found in 46/60 patients (77%). Antral hypomotility and pylorospasm were found in respectively 33% and 12% of patients. At least one neuropathic enteric dysmotility pattern was found in 58% of patients. No differences were found when comparing baseline ADM parameters between clinical response groups at 12 months follow-up. Following explorative analyses, no ADM parameters were identified to predict clinical response 12 months after G-POEM.
No ADM parameters were identified as predictors of clinical response after G-POEM in refractory GP patients. Additionally, a high percentage of abnormal ADM tracings was found, in particular with relation to enteric dysmotility, while only a low percentage of patients showed antral hypomotility or pylorospasm.
胃经口内镜下幽门肌切开术（G-POEM）是治疗难治性胃轻瘫（GP）的一种有前途的治疗方法。然而，由于适合 G-POEM 的患者特征尚不清楚，抗十二指肠测压（ADM）已被建议为患者选择提供客观参数。本研究的目的是确定 ADM 参数作为难治性 GP 患者 G-POEM 后治疗反应的预测指标。
纳入 2017 年至 2022 年间接受 G-POEM 的难治性 GP 患者。主要评分以下 ADM 参数：胃窦动力不足、幽门痉挛和存在神经源性肠动力模式。治疗反应定义为 G-POEM 后 12 个月 GCSI 评分至少降低 1 分。使用逻辑回归分析对反应的潜在预测因素进行探索性分析。
纳入难治性 GP 患者 60 例（女性 52 例，平均年龄 52±14 岁），包括特发性 33 例、糖尿病 16 例、术后 11 例。52 例患者可获得临床反应数据。在 60 例患者中，有 8 例不能将导管推进幽门。60 例患者中有 46/60 例（77%）存在异常 ADM。胃窦动力不足和幽门痉挛分别在 33%和 12%的患者中发现。58%的患者至少有一种神经源性肠动力障碍模式。在 12 个月随访时，两组患者的基线 ADM 参数无差异。经过探索性分析，没有发现 ADM 参数可预测 G-POEM 后 12 个月的临床反应。
在难治性 GP 患者中，未发现 ADM 参数可预测 G-POEM 后的临床反应。此外，发现异常 ADM 描记图的比例较高，特别是与肠动力障碍有关，而仅少数患者表现出胃窦动力不足或幽门痉挛。
