Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 7, Cleveland, OH, 44106, USA.
Department of Surgery, Case Western Reserve University, Cleveland, OH, USA.
Surg Endosc. 2024 Nov;38(11):6778-6781. doi: 10.1007/s00464-024-11178-y. Epub 2024 Aug 19.
Gastroparesis can be a debilitating disease process for which durable treatment options are lacking. While dietary changes and pharmacotherapy have some efficacy, symptoms frequently recur and some patients progress to needing supplemental enteral feeding access. Per oral pyloromyotomy (POP) has been shown to be a durable minimally invasive treatment option for refractory gastroparesis with a low side effect profile, and therefore has been performed at this institution for the past 6 years.
This was a retrospective case series of all patients who underwent a POP at a single institution over a 6-year period (2018-2023). Patient demographics, preoperative symptomatology and subsequent workup, postoperative complications, and symptom recurrence were collected and analyzed.
There were 56 patients included in the study. There was a 1.8:1 female:male ratio. The average patient age was 56 years old (range 23-85). The average duration of symptoms was 1-3 years. Thirty-eight percent of patients had undergone previous endoscopic therapy for gastroparesis (pyloric botox injection or pyloric dilation) and 16% of patients underwent multiple endoscopic therapies. Twenty-nine percent of patients were on a medication for gastroparesis. Past surgery was the most common gastroparesis etiology for POP (50% of patients). Diabetes (23%) and idiopathic (19%) were the other most common gastroparesis etiologies for POP. Nausea was the most common symptom at first follow-up (30%) but these patients continued to improve with 14% of patients continuing to endorse nausea at 6 months. Twenty-seven percent of patients developed symptom recurrence. Forty percent of patients with symptom recurrence underwent a repeat endoscopic or surgical therapy.
In this present study, POP leads to durable results in approximately 75% of patients with minimal complications. Furthermore, the majority of patients who do develop symptom recurrence do not require additional gastroparesis interventions.
胃轻瘫可能是一种使人虚弱的疾病过程，缺乏持久的治疗选择。虽然饮食改变和药物治疗有一定疗效，但症状经常复发，一些患者需要补充肠内喂养途径。经口幽门肌切开术（POP）已被证明是一种对难治性胃轻瘫具有持久疗效且副作用低的微创治疗选择，因此在过去 6 年中，该机构一直在进行这项手术。
这是一项对过去 6 年（2018-2023 年）在一家机构接受 POP 的所有患者进行的回顾性病例系列研究。收集和分析了患者的人口统计学资料、术前症状和后续检查、术后并发症以及症状复发情况。
研究纳入了 56 例患者。男女比例为 1.8:1。患者平均年龄为 56 岁（范围 23-85 岁）。平均症状持续时间为 1-3 年。38%的患者曾因胃轻瘫接受过内镜治疗（幽门肉毒杆菌注射或幽门扩张），16%的患者接受过多次内镜治疗。29%的患者正在服用治疗胃轻瘫的药物。过去的手术是 POP 最常见的胃轻瘫病因（50%的患者）。糖尿病（23%）和特发性（19%）是 POP 胃轻瘫的其他常见病因。初次随访时最常见的症状是恶心（30%），但这些患者仍在继续改善，14%的患者在 6 个月时仍有恶心症状。27%的患者出现症状复发。40%的症状复发患者接受了重复内镜或手术治疗。
在本研究中，POP 使约 75%的患者获得持久的结果，且并发症极少。此外，大多数出现症状复发的患者不需要额外的胃轻瘫干预。
