Alattar Husameddin, Dabit Michael, Desouza Melissa, Filicori Filippo, Dunst Christy M
Department of Global Health, University of Washington, Seattle, WA, USA.
Foundation for Surgical Innovation and Education, Portland, USA.
Surg Endosc. 2025 May 27. doi: 10.1007/s00464-025-11735-z.
Surgical referrals for refractory gastroparesis (GP) are becoming more common as medical options are limited. Supplemental intestinal alimentation via feeding jejunostomy tubes (JT) is required to treat underlying malnutrition in only the most severe cases. The aim of this study was to determine predictive factors associated with successful restoration of oral nutrition after insertion of a JT for patients with severe malnutrition associated with GP.
Retrospective review of all patients who had JT inserted between November 2007 and October 2023 at The Oregon Clinic for severe gastroparesis. Baseline demographics, comorbidities, objective studies, symptom scores and operative details were recorded. The primary outcome was successful return to independent oral intake defined as removal of the feeding tube without additional supplementation (TPN) at one year after the last procedure.
One hundred and eleven of 905 patients (12%) had JTs inserted during the study period. There was a total of 164 gastroparesis procedures including pyloric intervention (81), gastric neurostimulator (GNS) implantation (29), RNY gastrectomy (19), and fundoplication (35). Multiple procedures were performed in 48% during the disease course. Twenty-six (23.4%) patients achieved adequate return of oral intake and successful JT removal by 12 months, while (62%) required ongoing feeding access and/or TPN. Only pyloric intervention was independently associated with successful JT removal at one year (p = 0.011, OR 5.032, p = 0.045). Patients undergoing two procedures had the highest rate of JT removal within one year (36.6%, p = 0.036, OR 12.00, p = 0.022).
Malnutrition requiring feeding jejunostomy tubes is a rare complication of gastroparesis. When the disease has progressed to this stage, most patients remain j-tube dependent long-term despite surgical interventions. Pyloric intervention (laparoscopic pyloroplasty or endoscopic pyloromyotomy) substantially increases the likelihood of successful resumption of oral alimentation and subsequent liberation from feeding tubes. Pyloric intervention should be performed concurrently for any patient requiring a feeding jejunostomy for severe gastroparesis.
由于药物治疗选择有限，难治性胃轻瘫（GP）的手术转诊越来越普遍。仅在最严重的病例中，才需要通过空肠造口管（JT）进行补充肠道营养，以治疗潜在的营养不良。本研究的目的是确定与严重营养不良相关的GP患者插入JT后成功恢复经口营养的预测因素。
回顾性分析2007年11月至2023年10月在俄勒冈诊所因严重胃轻瘫插入JT的所有患者。记录基线人口统计学、合并症、客观检查、症状评分和手术细节。主要结局是成功恢复独立经口摄入，定义为在最后一次手术后一年，无需额外补充（全胃肠外营养）即可拔除喂养管。
在研究期间，905例患者中有111例（12%）插入了JT。共有164例胃轻瘫手术，包括幽门干预（81例）、胃神经刺激器（GNS）植入（29例）、Roux-en-Y胃切除术（19例）和胃底折叠术（35例）。48%的患者在病程中接受了多次手术。26例（23.4%）患者在12个月时实现了经口摄入充分恢复并成功拔除JT，而62%的患者需要持续的喂养途径和/或全胃肠外营养。仅幽门干预与一年时成功拔除JT独立相关（p = 0.011，OR 5.032，p = 0.045）。接受两次手术的患者在一年内拔除JT的比例最高（36.6%，p = 0.036，OR 12.00，p = 0.022）。
需要空肠造口管喂养的营养不良是胃轻瘫的一种罕见并发症。当疾病进展到这一阶段时，尽管进行了手术干预，大多数患者长期仍依赖空肠造口管。幽门干预（腹腔镜幽门成形术或内镜下幽门肌切开术）显著增加了成功恢复经口营养并随后摆脱喂养管的可能性。对于任何因严重胃轻瘫需要空肠造口管喂养的患者，应同时进行幽门干预。
