Short-term outcomes of double versus single pyloromyotomy at peroral endoscopic pyloromyotomy in the treatment of gastroparesis (with video).,Gastrointestinal Endoscopy

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Short-term outcomes of double versus single pyloromyotomy at peroral endoscopic pyloromyotomy in the treatment of gastroparesis (with video).
Gastrointestinal Endoscopy ( IF 6.7 ) Pub Date : 2020-01-17 , DOI: 10.1016/j.gie.2020.01.016
Mohamed M Abdelfatah ₁ , Baiwen Li ₂ , Neil Kapil ₁ , Alan Noll ₁ , Lianyong Li ₃ , Hui Luo ₄ , Huimin Chen ₅ , Liang Xia ₆ , Xiangbo Chen ₇ , Vailshali Patel ₁ , Parit Mekaroonkamol ₁ , Julia Massaad ₁ , Steven Keilin ₁ , Qiang Cai ₁

Affiliation

Emory University School of Medicine, Division of Digestive Diseases, Atlanta, Georgia, USA.
Emory University School of Medicine, Division of Digestive Diseases, Atlanta, Georgia, USA; Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Emory University School of Medicine, Division of Digestive Diseases, Atlanta, Georgia, USA; Department of Gastroenterology, PLA Strategic Support Force Characteristic Medical Center, Beijing, China.
Emory University School of Medicine, Division of Digestive Diseases, Atlanta, Georgia, USA; State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi.
Emory University School of Medicine, Division of Digestive Diseases, Atlanta, Georgia, USA; Division of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Emory University School of Medicine, Division of Digestive Diseases, Atlanta, Georgia, USA; Department of Gastroenterology, The First Affiliated Hospital of Nanchang University. Nanchang, Jiangxi, China.
Department of Gastroenterology, Fujian Quanzhou Hospital. Quanzhou, Fujian, China.

Background and Aims

The prevalence of gastroparesis (Gp), a chronic debilitating disorder, and resulting hospitalizations are increasing. Gastric peroral endoscopic pyloromyotomy (POP or GPOEM) is a novel technique in the treatment of refractory Gp. Despite the initial promising results of GPOEM, one-third of patients do not exhibit any clinical response. Furthermore, loss of clinical response was reported in several studies. No response or loss of response after GPOEM may be related to inadequate myotomy. The aim of our study is to examine whether double pyloromyotomy at GPOEM is superior to single pyloromyotomy.

Method

A retrospective case-controlled study of patients who underwent GPOEM for refractory Gp at our tertiary care institution between June 2015 and March 2018 was performed. Because the follow-up time for the single myotomy group was much longer than that of the double myotomy group, we matched the length of follow-up for the single myotomy group to that of the double myotomy group. The outcomes were measured by the changes in the Gastroparesis Cardinal Symptom Index (GCSI) before and 3 to 6 months after the procedure. Adverse events and other procedural and clinical parameters were also compared.

Results

Ninety patients underwent GPOEM (55 single and 35 double pyloromyotomy). The mean age was 47 ± 14 years, and the mean duration of symptoms was 5.3 ± 4.4 years. The average GCSI score was 3.8 before the GPOEM, and the average GCSI score 6 months after procedure was 1.8. Thirty-seven of 55 (67%) patients who underwent single pyloromyotomy achieved clinical response compared with 30 of 35 (86%) patients who underwent double pyloromyotomy. There were no significant differences for procedure time, postoperative pain, or length of hospital stay between the 2 groups. There was no difference in adverse events in the 2 pyloromyotomy groups.

Conclusion

Double pyloromyotomy is a safe and feasible technique during GPOEM. Clinical success was higher in patients undergoing double pyloromyotomy compared with single pyloromyotomy in this nonrandomized, short-term follow-up study. Long-term studies are needed to further confirm our results.

中文翻译：

经胃内镜下幽门切开术治疗胃轻瘫的双重与单一幽门切开术的近期结果（视频）。

背景和目标

胃轻瘫（Gp）（一种慢性衰弱性疾病）的患病率以及由此引起的住院治疗正在增加。胃内镜下幽门肌切开术（POP或GPOEM）是治疗难治性Gp的一种新技术。尽管GPOEM最初取得了令人鼓舞的结果，但仍有三分之一的患者未表现出任何临床反应。此外，几项研究报道了临床反应的丧失。GPOEM后无反应或反应丧失可能与肌切开术不足有关。我们研究的目的是检查GPOEM的双幽门切开术是否优于单幽门切开术。

方法

对2015年6月至2018年3月间在我们的三级医疗机构接受GPOEM治疗难治性Gp的患者进行了一项病例对照研究。由于单肌切开组的随访时间比双肌切开组的随访时间长得多，因此我们将单肌切开组的随访时间与双肌切开组的随访时间相匹配。通过手术前和手术后3至6个月的胃轻瘫基本症状指数（GCSI）的变化来衡量结局。还比较了不良事件以及其他程序和临床参数。

结果

90名患者接受了GPOEM（55次单次幽门切开术和35次双次幽门切开术）。平均年龄为47±14岁，平均症状持续时间为5.3±4.4岁。GPOEM之前的平均GCSI评分为3.8，而术后6个月的平均GCSI评分为1.8。在进行单次幽门切开术的55名患者中，有37名（67％）达到了临床反应，而在进行了两次幽门切开术的35名患者中有30名（86％）获得了临床反应。两组之间的手术时间，术后疼痛或住院时间无显着差异。2例幽门切开术组的不良反应没有差异。