Shargo Ryan, Poonen-Honig Isaac, Thélin Camille, DuCoin Christopher G, Mhaskar Rahul, Docimo Salvatore, Sujka Joseph A
Department of Medical Education, University of South Florida Morsani College of Medicine, Tampa, USA.
Department of Gastroenterology, University of South Florida Morsani College of Medicine, Tampa, USA.
Cureus. 2025 Feb 15;17(2):e79056. doi: 10.7759/cureus.79056. eCollection 2025 Feb.
Treatment options for medication- and diet-resistant gastroparesis include drainage procedures such as pyloroplasty and gastric peroral endoscopic myotomy (G-POEM). While dumping syndrome (DS) and bile acid gastritis (BAG) have been documented as complications following pyloric drainage procedures, limited evidence exists concerning their incidence after pyloroplasty and G-POEM for refractory gastroparesis. We performed a systematic review of outcomes following pyloroplasty and G-POEM for refractory gastroparesis (PROSPERO: CRD42024559654). PubMed, Embase, Cochrane, and Web of Science databases were systematically searched for articles reporting rates of DS and BAG following pyloric drainage procedures. Assessed outcomes included rates of DS and BAG. Results were narratively synthesized and presented descriptively. Of the 2278 records reviewed, 10 studies were included. Six studies evaluated pyloroplasty, and four studies evaluated G-POEM. Nine studies reported incidence of DS, and two studies reported rates of BAG. The incidence of DS ranged from 0% to 23.1%, with a median incidence of 3.23% and an interquartile range of 6.95% among nine studies. The incidence of BAG ranged from 0% to 15.4% in two studies. The studies displayed high heterogeneity in study design, patient population, and co-interventions, precluding collective data analysis and limiting generalizability. All studies displayed a moderate to serious risk of bias. There exists a paucity of data regarding the incidence of DS and BAG following pyloroplasty and G-POEM for refractory gastroparesis. Despite the theoretical association of these complications with pylorus-modifying procedures, our findings suggest that they may be uncommon or underreported in the treatment of refractory gastroparesis. Improved reporting of these outcomes and robust prospective studies investigating the incidence of such complications are required.
对于药物和饮食治疗无效的胃轻瘫，治疗选择包括引流手术，如幽门成形术和经口内镜下胃肌切开术（G-POEM）。虽然倾倒综合征（DS）和胆汁反流性胃炎（BAG）已被记录为幽门引流手术后的并发症，但关于幽门成形术和G-POEM治疗难治性胃轻瘫后它们的发生率的证据有限。我们对幽门成形术和G-POEM治疗难治性胃轻瘫的结果进行了系统评价（PROSPERO：CRD42024559654）。系统检索了PubMed、Embase、Cochrane和Web of Science数据库，以查找报告幽门引流手术后DS和BAG发生率的文章。评估的结果包括DS和BAG的发生率。结果进行了叙述性综合并以描述性方式呈现。在审查的2278条记录中，纳入了10项研究。6项研究评估了幽门成形术，4项研究评估了G-POEM。9项研究报告了DS的发生率，2项研究报告了BAG的发生率。在9项研究中，DS的发生率范围为0%至23.1%，中位发生率为3.23%，四分位间距为6.95%。在2项研究中，BAG的发生率范围为0%至15.4%。这些研究在研究设计、患者群体和联合干预方面表现出高度异质性，排除了汇总数据分析并限制了普遍性。所有研究都显示出中度至严重的偏倚风险。关于幽门成形术和G-POEM治疗难治性胃轻瘫后DS和BAG的发生率的数据很少。尽管这些并发症在理论上与幽门改变手术有关，但我们的研究结果表明，它们在难治性胃轻瘫的治疗中可能并不常见或报告不足。需要改进这些结果的报告，并进行有力的前瞻性研究来调查此类并发症的发生率。
