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

被引：3

作者：

Debourdeau, Antoine ^{[1
]}

Vitton, Veronique ^{[2
]}

Gonzalez, Sandra ^{[3
]}

Collet, Henri ^{[4
]}

Al Tabaa, Yassine ^{[4
]}

Barthet, Marc ^{[2
]}

Gonzalez, Jean-Michel ^{[2
]}

机构：

[1] Montpellier Univ, Gastroenterol Unit, CHU Nimes, CHU Montpellier,I SITE MUSE, Montpellier, France

[2] Aix Marseille Univ, Hop Nord Marseille, AP HM, Gastroenterol Unit, Marseille, France

[3] Aix Marseille Univ, Timone Hosp Marseille, AP HM, Nucl Med Dept, Marseille, France

[4] Clin Clementville, Scintidoc Nucl Med Ctr, Montpellier, France

来源：

GASTROINTESTINAL ENDOSCOPY | 2025年 / 101卷 / 03期

关键词：

D O I：

10.1016/j.gie.2024.05.011

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

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 GPOEM. (Gastrointest Endosc 2025;101:598-607.)

引用

页码：598 / 607

页数：10

共 25 条

[1] Ye Y., Jiang B., Manne S., Et al., Epidemiology and outcomes of gastroparesis, as documented in general practice records, in the United Kingdom, Gut, 70, pp. 644-653, (2021)
[2] Azpiroz F., Malagelada J.R., Gastric tone measured by an electronic barostat in health arid postsurgical gastroparesis, Gastroenterology, 92, pp. 934-943, (1987)
[3] Bredenoord A.J., Chial H.J., Camilleri M., Mullan B.P., Murray J.A., Gastric accommodation and emptying in evaluation of patients with upper gastrointestinal symptoms, Clin Gastroenterol Hepatol, 1, pp. 264-272, (2003)
[4] Tack J., Camilleri M., New developments in the treatment of gastroparesis and functional dyspepsia, Curr Opin Pharmacol, 43, pp. 111-117, (2018)
[5] Camilleri M., Relationship of motor mechanisms to gastroparesis symptoms: toward individualized treatment, Am J Physiol Gastrointest Liver Physiol, 320, pp. G558-G563, (2021)
[6] Gourcerol G., Tissier F., Melchior C., Et al., Impaired fasting pyloric compliance in gastroparesis and the therapeutic response to pyloric dilatation, Aliment Pharm Therap, 41, pp. 360-367, (2015)
[7] Khashab M.A., Stein E., Clarke J.O., Et al., Gastric peroral endoscopic myotomy for refractory gastroparesis: first human endoscopic pyloromyotomy (with video), Gastrointest Endosc, 78, pp. 764-768, (2013)
[8] Martinek J., Hustak R., Mares J., Et al., Endoscopic pyloromyotomy for the treatment of severe and refractory gastroparesis: a pilot, randomised, sham-controlled trial, Gut, 71, pp. 2170-2178, (2022)
[9] Vosoughi K., Ichkhanian Y., Benias P., Et al., Gastric per-oral endoscopic myotomy (G-POEM) for refractory gastroparesis: results from an international prospective trial, Gut, 71, pp. 25-33, (2022)
[10] Labonde A., Lades G., Debourdeau A., Et al., Gastric peroral endoscopic myotomy in refractory gastroparesis: long-term outcomes and predictive score to improve patient selection, Gastrointest Endosc, 96, pp. 500-508.e2, (2022)

← 1 2 3 →