Background and Aims

Gastric per-oral endoscopic pyloromyotomy (GPOEM) is a novel procedure with promising potential for the treatment of gastroparesis but with limited data regarding predictors of clinical response. This study aims to evaluate the safety and efficacy of the procedure and explore the impact of duration and etiology (diabetic vs nondiabetic) of gastroparesis on clinical outcome as measured by the Gastroparesis Cardinal Symptom Index (GCSI).

Methods

A single-center retrospective longitudinal study at a tertiary care hospital was performed over an 18-month period. Forty patients with refractory gastroparesis (25 nondiabetic and 15 diabetic patients) were included.

Results

GCSI significantly improved throughout the study period (F[2.176, 17.405] = 10.152, P = .001). The nausea/vomiting subscale showed sustained improvement through 18 months (F[2.213, 17.704] = 15.863, P < .00001). There was no significant improvement in bloating (F[2.099, 16.791] = 1.576, P = .236). Gastric scintigraphy retention was significantly reduced by 41.7% (t = –7.90; P < .00001). Multivariate linear regression modeling revealed a significant correlation between the duration of disease and a GCSI improvement at 12 months (P = .02), with a longer duration of disease associated with a poorer long-term response. The etiology of gastroparesis was not associated with clinical improvement (P = .16). Adverse events (7.5%) included 1 capnoperitoneum, 1 periprocedure chronic obstructive pulmonary disease exacerbation, and 1 mucosotomy closure site disruption.

Conclusions

GPOEM appears to be a safe and effective minimally invasive therapy for refractory gastroparesis, especially for patients with predominant nausea/vomiting and shorter duration of disease, regardless of the etiology. We propose the clinical criteria for undergoing GPOEM should be a GCSI of at least 2.0 and a gastric retention of greater than 20%.

中文翻译：

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胃口内镜下幽门切开术后胃轻瘫持续时间或病因与临床反应之间的关系

背景和目标

胃经口内镜下幽门切开术（GPOEM）是一种新颖的方法，具有治疗胃轻瘫的潜力，但有关临床反应预测因素的数据有限。这项研究的目的是评估该过程的安全性和有效性，并探讨胃轻瘫的病程和病因（糖尿病与非糖尿病）对临床结果的影响，以胃轻瘫主要症状指数（GCSI）来衡量。

方法

在18个月的时间里，对三级医院进行了单中心回顾性纵向研究。包括40例难治性胃轻瘫患者（25例非糖尿病患者和15例糖尿病患者）。

结果

在整个研究期间，GCSI均得到显着改善（F [2.176，17.405] = 10.152，P  = .001）。恶心/呕吐分量表显示持续改善至18个月（F [2.213，17.704] = 15.863，P  < .00001 ）。腹胀没有显着改善（F [2.099，16.791] = 1.576，P  = 0.236）。胃闪烁显像保留率显着降低了41.7％（t  = –7.90；P  < .00001 ）。多元线性回归模型显示疾病持续时间与12个月GCSI改善之间存在显着相关性（P = .02），病程较长，长期反应较差。胃轻瘫的病因与临床改善无相关性（P  = 0.16）。不良事件（7.5％）包括1例腹膜炎，1例围手术期慢性阻塞性肺疾病恶化和1例粘膜切开术封闭位点破坏。

结论

GPOEM对于顽固性胃轻瘫来说似乎是一种安全有效的微创疗法，特别是对于恶心/呕吐和病程短的患者，无论其病因如何。我们建议进行GPOEM的临床标准应为GCSI至少为2.0，且胃retention留大于20％。