Prognostic value of preoperative intragastric meal distribution in gastric emptying scintigraphy for long-term success of gastric peroral endoscopic myotomy in gastroparesis

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy Pub Date : 2025-03-01 DOI:10.1016/j.gie.2024.05.011

Antoine Debourdeau MD , Véronique Vitton MD, PhD , Sandra Gonzalez MD, PhD , Henri Collet MD , Yassine Al Tabaa MD , Marc Barthet MD, PhD , Jean-Michel Gonzalez MD, PhD

{"title":"Prognostic value of preoperative intragastric meal distribution in gastric emptying scintigraphy for long-term success of gastric peroral endoscopic myotomy in gastroparesis","authors":"Antoine Debourdeau MD , Véronique Vitton MD, PhD , Sandra Gonzalez MD, PhD , Henri Collet MD , Yassine Al Tabaa MD , Marc Barthet MD, PhD , Jean-Michel Gonzalez MD, PhD","doi":"10.1016/j.gie.2024.05.011","DOIUrl":null,"url":null,"abstract":"<div><h3>Background and Aims</h3><div>Gastric emptying scintigraphy (GES) is the criterion standard for the diagnosis of gastroparesis. However, data are lacking regarding the prognostic value of preoperative intragastric meal distribution during GES in patients undergoing gastric peroral endoscopic myotomy (G-POEM) for gastroparesis. This study investigated the association of GES morphologic parameters and the long-term clinical success of G-POEM.</div></div><div><h3>Methods</h3><div>This retrospective study included patients who underwent G-POEM for refractory gastroparesis in a tertiary center with preoperative GES data. Intragastric meal distribution was measured using the proximal to distal count ratio (PDCR) at 0, 1, 2 and 4 hours, and the retention index was calculated. Clinical success was defined as a decrease of at least 50% in the Gastroparesis Cardinal Symptom Index total score after G-POEM.</div></div><div><h3>Results</h3><div>In total, 77 patients were included with a mean follow-up of 40.14 months. Clinical success was observed in 54.55% of patients. The retention index was not associated with clinical success. Only PDCR at 0 hours (PDCR0) was associated with clinical success. In univariate analysis, the median PDCR0 was 6.0 (interquartile range, 5.59) in patients with clinical success and 4.29 (interquartile range, 4.51) in patients with clinical failure (<em>P</em> = .019). In multivariate analysis, PDCR0 >5.25 was associated with clinical success (odds ratio, 4.36; 95% confidence interval, 1.55-12.26; <em>P</em> = .00524).</div></div><div><h3>Conclusions</h3><div>This study suggests that in patients with gastroparesis, a high PDCR0 value (suggestive for a preferential fundic meal distribution) during preoperative GES is associated with long-term clinical response to G-POEM.</div></div>","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":"101 3","pages":"Pages 598-607"},"PeriodicalIF":6.7000,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Gastrointestinal endoscopy","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0016510724032073","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background and Aims

Gastric emptying scintigraphy (GES) is the criterion standard for the diagnosis of gastroparesis. However, data are lacking regarding the prognostic value of preoperative intragastric meal distribution during GES in patients undergoing gastric peroral endoscopic myotomy (G-POEM) for gastroparesis. This study investigated the association of GES morphologic parameters and the long-term clinical success of G-POEM.

Methods

This retrospective study included patients who underwent G-POEM for refractory gastroparesis in a tertiary center with preoperative GES data. Intragastric meal distribution was measured using the proximal to distal count ratio (PDCR) at 0, 1, 2 and 4 hours, and the retention index was calculated. Clinical success was defined as a decrease of at least 50% in the Gastroparesis Cardinal Symptom Index total score after G-POEM.

Results

In total, 77 patients were included with a mean follow-up of 40.14 months. Clinical success was observed in 54.55% of patients. The retention index was not associated with clinical success. Only PDCR at 0 hours (PDCR0) was associated with clinical success. In univariate analysis, the median PDCR0 was 6.0 (interquartile range, 5.59) in patients with clinical success and 4.29 (interquartile range, 4.51) in patients with clinical failure (P = .019). In multivariate analysis, PDCR0 >5.25 was associated with clinical success (odds ratio, 4.36; 95% confidence interval, 1.55-12.26; P = .00524).

Conclusions

This study suggests that in patients with gastroparesis, a high PDCR0 value (suggestive for a preferential fundic meal distribution) during preoperative GES is associated with long-term clinical response to G-POEM.

Abstract Image

查看原文本刊更多论文

胃排空闪烁成像中的术前胃内进食分布对胃瘫胃口周围内镜肌切开术长期成功的预后价值

背景和目的：胃排空闪烁成像（GES）是诊断胃瘫的金标准。然而，对于因胃瘫而接受胃口周围内镜下肌切开术（GPOEM）的患者，目前还缺乏有关 GES 术前胃内膳食分布预后价值的数据。本研究调查了 GES 形态学参数与 G-POEM 长期临床成功率的关系：这项回顾性研究纳入了在一家三级中心接受G-POEM治疗难治性胃瘫并提供术前GES数据的患者。使用近端与远端计数比（PDCR）测量0、1、2和4小时（h）的胃内膳食分布，并计算潴留指数（RI）。临床成功的定义是，G-POEM 术后胃痉挛卡迪纳尔症状指数（GCSI）总分下降至少 50%：共有 77 名患者接受了治疗，平均随访时间为 40.14 个月。54.55%的患者获得了临床成功。RI与临床成功率无关。只有 0h 时的 PDCR（PDCR0）与临床成功率相关。在单变量分析中，临床成功患者的中位 PDCR0 为 6.0（IQR 5.59），临床失败患者的中位 PDCR0 为 4.29（IQR 4.51）（P=0.019）。在多变量分析中，PDCR0>5.25与临床成功相关（HR=4.36 [1.55;12.26]，P=0.00524）：本研究表明，对于胃瘫患者，术前胃肠造影时的高 PDCR0 值（提示胃底膳食优先分布）与 G-POEM 的长期临床反应相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Gastrointestinal endoscopy 医学-胃肠肝病学

CiteScore

10.30

自引率

7.80%

发文量

1441

审稿时长

38 days

期刊介绍： Gastrointestinal Endoscopy is a journal publishing original, peer-reviewed articles on endoscopic procedures for studying, diagnosing, and treating digestive diseases. It covers outcomes research, prospective studies, and controlled trials of new endoscopic instruments and treatment methods. The online features include full-text articles, video and audio clips, and MEDLINE links. The journal serves as an international forum for the latest developments in the specialty, offering challenging reports from authorities worldwide. It also publishes abstracts of significant articles from other clinical publications, accompanied by expert commentaries.