First Description of Redo Gastric Per-Oral Endoscopic Myotomy for Refractory Gastroparesis: Technical Conduct and Outcomes.

IF 1.1 4区 医学 Q3 SURGERY
Mélissa V Wills, Valentin Mocanu, Sol Lee, Salvador Navarrete, John Rodriguez, Andrew Strong, Jerry Dang, Matthew Allemang, Matthew Kroh
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引用次数: 0

Abstract

Introduction: Gastroparesis is a progressive disease that may require endoscopic or surgical intervention, such as gastric per oral endoscopic myotomy (G-POEM), when conservative measures are ineffective or not tolerated. Limited data exist on redo G-POEM safety and effectiveness. We describe outcomes of patients undergoing repeat G-POEM for refractory gastroparesis. Methods: A retrospective review of patients who underwent redo G-POEM at our center from 2008 to 2024. Data included demographics, gastroparesis etiology, previous treatments, Gastroparesis Cardinal Symptom Index (GCSI), gastric emptying studies (GES), and clinical outcomes. Results: Three patients (mean age at first G-POEM 52.3 ± 19 years) were identified. All procedures were technically successful, and all 3 patients survived to discharge without major complications. Patient A (sarcoidosis-induced gastroparesis) had transient symptomatic improvement after the first G-POEM, but symptoms deteriorated the following year. GES showed initial improvement (26% to 14% 4-hour retention) but returned to baseline (26%) after the second G-POEM. She ultimately required jejunostomy tube placement. Patient B (idiopathic gastroparesis) with a history of renal transplant showed no objective improvement in GES after either procedure (40% to 41% 4-hour retention) and remained noncompliant with dietary recommendations. He died at age 35 from cardiac arrhythmia 2 years after the second G-POEM. Patient C (postsurgical gastroparesis) had improvement in GES after the first G-POEM (88% to 53% 4-hour retention) but then deteriorated to 73% despite symptomatic improvement. After symptom recurrence, redo G-POEM provided an excellent symptomatic response, but she remained total parenteral nutrition-dependent until death 4 years later. Conclusion: While redo G-POEM is technically feasible and safe, our case series demonstrates poor long-term clinical outcomes across different gastroparesis etiologies. All 3 patients experienced treatment failure, with 2 requiring permanent nutritional support and 1 showing a lack of symptomatic response. These findings may suggest limited utility of redo G-POEM and highlight the need for careful patient selection.

对难治性胃轻瘫进行胃经口内窥镜切开术的首次描述:技术行为和结果。
胃轻瘫是一种进行性疾病,当保守措施无效或不能耐受时,可能需要内镜或手术干预,如胃经口内镜下肌切开术(G-POEM)。关于重做G-POEM安全性和有效性的数据有限。我们描述了难治性胃轻瘫患者接受重复G-POEM治疗的结果。方法:回顾性分析2008年至2024年在我中心接受重做G-POEM的患者。数据包括人口统计学、胃轻瘫病因、既往治疗、胃轻瘫主要症状指数(GCSI)、胃排空研究(GES)和临床结果。结果:确定了3例患者(平均首次G-POEM年龄52.3±19岁)。所有手术在技术上都是成功的,3例患者均存活至出院,无重大并发症。患者A(结节病诱发的胃轻瘫)在第一次G-POEM后有短暂的症状改善,但第二年症状恶化。GES表现出最初的改善(4小时保留率为26%至14%),但在第二次G-POEM后恢复到基线(26%)。她最终需要空肠造口管置入。有肾移植史的患者B(特发性胃轻瘫)在两种手术后GES均无客观改善(4小时滞留40%至41%),且仍不符合饮食建议。他在第二次G-POEM术后2年死于心律失常,享年35岁。患者C(术后胃轻瘫)在第一次G-POEM后GES有所改善(4小时保留88%至53%),但随后恶化至73%,尽管症状有所改善。症状复发后,重做G-POEM提供了极好的症状缓解,但她仍然完全依赖肠外营养,直到4年后死亡。结论:虽然重做G-POEM在技术上是可行和安全的,但我们的病例系列表明,不同胃轻瘫病因的长期临床结果不佳。3例患者均治疗失败,其中2例需要永久性营养支持,1例缺乏症状反应。这些发现可能表明重做G-POEM的效用有限,并强调需要仔细选择患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.90
自引率
0.00%
发文量
163
审稿时长
3 months
期刊介绍: Journal of Laparoendoscopic & Advanced Surgical Techniques (JLAST) is the leading international peer-reviewed journal for practicing surgeons who want to keep up with the latest thinking and advanced surgical technologies in laparoscopy, endoscopy, NOTES, and robotics. The Journal is ideally suited to surgeons who are early adopters of new technology and techniques. Recognizing that many new technologies and techniques have significant overlap with several surgical specialties, JLAST is the first journal to focus on these topics both in general and pediatric surgery, and includes other surgical subspecialties such as: urology, gynecologic surgery, thoracic surgery, and more.
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