一种新的胃经口内镜下肌切开术后临床结局分类与管理的国际方案。

A New International Scheme for the Classification and Management of Clinical Outcomes Post-gastric Peroral Endoscopic Myotomy.

作者信息

Ichkhanian Yervant, Salame Marita, Wo John M, Nowak Thomas V, Stainko Sarah, Saito Akira, Siwiec Robert M, Kais Amr, Hwang Joo Ha, Li Andrew A, Yang Juliana, Broucek Joseph R, Esfandyari Tuba, Joseph Stephanie, Ujiki Michael B, Williams Ashley E, Moremen Jacob, Gouda Zane, Schlachterman Alexander, Hugova Kristina, Martinek Jan, Geng Calvin X, Podboy Alexander, Wang Andrew Y, Lajin Michael, Gregor Lennon, Miller Payton M, Al Bunni Hashem, DeWitt John M, Al-Haddad Mohammad

机构信息

Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana.

Division of Gastroenterology and Hepatology, Stanford University, Stanford, California.

出版信息

Clin Gastroenterol Hepatol. 2025 May 14. doi: 10.1016/j.cgh.2025.03.022.

DOI:10.1016/j.cgh.2025.03.022

PMID:40378985

Abstract

BACKGROUND & AIMS: Gastric peroral endoscopic myotomy (G-POEM) is an emerging treatment for gastroparesis, but clinical outcomes can be inconsistent; hence, it is vital to enhance our management strategies for patients with clinical failure.

METHODS

This was a multicenter retrospective review of patients who underwent G-POEM for refractory gastroparesis from September 2015 to November 2023. Clinical outcomes and management post-G-POEM were assessed and categorized into 4 types based on symptom improvement and gastric emptying metrics.

RESULTS

Of the 482 patients, 221 (46%) underwent evaluations with pre- and post-G-POEM gastric emptying tests and were included in the study. Type 1 clinical response (clinical success with improved gastric emptying scintigraphy [GES]) was the most common outcome, occurring in 56%. This was followed by type 4 (clinical failure with no GES improvement) at 23%, type 2 (clinical failure with improved GES) at 15%, and type 3 (clinical success with no GES improvement) at 6.7%. Patients with primary clinical failure (types 2 and 4) showed significantly higher daily opioid use at 23%, compared with 7% in types 1 and 3 (P = .032). Clinical failure overall was observed in 60% during a median follow-up of 48 months, with 31% managed by pylorus-directed retreatment and 7% with gastric neurostimulator placement. In the type 1 response group, clinical success was re-established in 71% following pylorus-directed therapies, with repeat G-POEM being an independent predictor of clinical success post-re-treatment (odds ratio, 2.2; P = .02).

CONCLUSION

Our study highlights the importance of post-G-POEM GES assessments for characterizing clinical responses. Type 1 responders are more likely to benefit from subsequent pylorus-directed re-treatments, particularly repeat G-POEM interventions.

CLINICALTRIALS

gov, Number: NCT04434781.

摘要

背景与目的

经口内镜下胃肌切开术（G-POEM）是一种新兴的胃轻瘫治疗方法，但临床疗效可能不一致；因此，加强对临床治疗失败患者的管理策略至关重要。

方法

这是一项对2015年9月至2023年11月因难治性胃轻瘫接受G-POEM治疗的患者进行的多中心回顾性研究。评估了G-POEM后的临床疗效和管理情况，并根据症状改善和胃排空指标分为4种类型。

结果

482例患者中，221例（46%）进行了G-POEM前后的胃排空试验评估并纳入研究。1型临床反应（临床成功且胃排空闪烁扫描[GES]改善）是最常见的结果，占56%。其次是4型（临床失败且GES无改善），占23%；2型（临床失败但GES改善），占15%；3型（临床成功但GES无改善），占6.7%。原发性临床失败（2型和4型）的患者每日阿片类药物使用率显著更高，为23%，而1型和3型为7%（P = 0.032）。在中位随访48个月期间，总体临床失败率为60%，31%通过幽门定向再治疗，7%通过放置胃神经刺激器进行管理。在1型反应组中，幽门定向治疗后71%重新建立了临床成功，重复G-POEM是再治疗后临床成功的独立预测因素（比值比，2.2；P = 0.02）。