Cargando…
Gastric Peroral Endoscopic Myotomy (G-POEM) as a Treatment for Refractory Gastroparesis: Long-Term Outcomes
BACKGROUND AND AIMS: Gastric peroral endoscopic myotomy (G-POEM) has been regarded as a novel and minimally invasive therapy for refractory gastroparesis. This study reports the long-term outcomes and possible predictive factors for successful outcomes after G-POEM in an Asian population. METHODS: T...
Autores principales: | , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Hindawi
2018
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6217887/ https://www.ncbi.nlm.nih.gov/pubmed/30425974 http://dx.doi.org/10.1155/2018/6409698 |
_version_ | 1783368368884023296 |
---|---|
author | Xu, Jiaxin Chen, Tianyin Elkholy, Shaimaa Xu, Meidong Zhong, Yunshi Zhang, Yiqun Chen, Weifeng Qin, Wenzheng Cai, Mingyan Zhou, Pinghong |
author_facet | Xu, Jiaxin Chen, Tianyin Elkholy, Shaimaa Xu, Meidong Zhong, Yunshi Zhang, Yiqun Chen, Weifeng Qin, Wenzheng Cai, Mingyan Zhou, Pinghong |
author_sort | Xu, Jiaxin |
collection | PubMed |
description | BACKGROUND AND AIMS: Gastric peroral endoscopic myotomy (G-POEM) has been regarded as a novel and minimally invasive therapy for refractory gastroparesis. This study reports the long-term outcomes and possible predictive factors for successful outcomes after G-POEM in an Asian population. METHODS: This is a retrospective single-centre study of 16 patients who underwent G-POEM for refractory gastroparesis from August 2016 to October 2017. This study included 11 males and 5 females; in addition, 13 patients had postsurgical gastroparesis, and 3 patients had diabetes. The patients included had severe and refractory gastroparesis, as indicated by a Gastroparesis Cardinal Symptom Index (GCSI) score ≥20, and evidence of a delay on gastric emptying scintigraphy (GES). The primary outcome parameter was an assessment of the long-term clinical efficacy of the procedure. The secondary outcome parameter was the detection of possible predictive factors for success and the determination of cut-off values for such predictors. RESULTS: Technical success was achieved in 100% of the patients, with a mean procedure time of 45.25±12.96 min. The long-term clinical response was assessed in all patients during a median follow-up of 14.5 months. Clinical success was achieved in 13 (81.25%) patients. There was a significant reduction in the GCSI scores and GES values after the procedure compared to the baseline values, with P values of <0.0001 and 0.012, respectively. Univariate regression analysis showed that the GCSI and GES had significant associations with the future clinical outcomes of the patients, but this finding was not confirmed in multivariate analysis. A GCSI cut-off score of ≤30 had a high sensitivity and a negative predictive value (NPV) of 100% for predicting a successful procedure. GES (half emptying time ≤221.6 min and 2-hour retention ≤78.6%) had a high specificity and a positive predictive value (PPV) of 100%. CONCLUSIONS: G-POEM is a safe and effective treatment option with a long-term efficacy of 81.6%. GCSI and GES could serve as good predictive measures. |
format | Online Article Text |
id | pubmed-6217887 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Hindawi |
record_format | MEDLINE/PubMed |
spelling | pubmed-62178872018-11-13 Gastric Peroral Endoscopic Myotomy (G-POEM) as a Treatment for Refractory Gastroparesis: Long-Term Outcomes Xu, Jiaxin Chen, Tianyin Elkholy, Shaimaa Xu, Meidong Zhong, Yunshi Zhang, Yiqun Chen, Weifeng Qin, Wenzheng Cai, Mingyan Zhou, Pinghong Can J Gastroenterol Hepatol Clinical Study BACKGROUND AND AIMS: Gastric peroral endoscopic myotomy (G-POEM) has been regarded as a novel and minimally invasive therapy for refractory gastroparesis. This study reports the long-term outcomes and possible predictive factors for successful outcomes after G-POEM in an Asian population. METHODS: This is a retrospective single-centre study of 16 patients who underwent G-POEM for refractory gastroparesis from August 2016 to October 2017. This study included 11 males and 5 females; in addition, 13 patients had postsurgical gastroparesis, and 3 patients had diabetes. The patients included had severe and refractory gastroparesis, as indicated by a Gastroparesis Cardinal Symptom Index (GCSI) score ≥20, and evidence of a delay on gastric emptying scintigraphy (GES). The primary outcome parameter was an assessment of the long-term clinical efficacy of the procedure. The secondary outcome parameter was the detection of possible predictive factors for success and the determination of cut-off values for such predictors. RESULTS: Technical success was achieved in 100% of the patients, with a mean procedure time of 45.25±12.96 min. The long-term clinical response was assessed in all patients during a median follow-up of 14.5 months. Clinical success was achieved in 13 (81.25%) patients. There was a significant reduction in the GCSI scores and GES values after the procedure compared to the baseline values, with P values of <0.0001 and 0.012, respectively. Univariate regression analysis showed that the GCSI and GES had significant associations with the future clinical outcomes of the patients, but this finding was not confirmed in multivariate analysis. A GCSI cut-off score of ≤30 had a high sensitivity and a negative predictive value (NPV) of 100% for predicting a successful procedure. GES (half emptying time ≤221.6 min and 2-hour retention ≤78.6%) had a high specificity and a positive predictive value (PPV) of 100%. CONCLUSIONS: G-POEM is a safe and effective treatment option with a long-term efficacy of 81.6%. GCSI and GES could serve as good predictive measures. Hindawi 2018-10-22 /pmc/articles/PMC6217887/ /pubmed/30425974 http://dx.doi.org/10.1155/2018/6409698 Text en Copyright © 2018 Jiaxin Xu et al. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Clinical Study Xu, Jiaxin Chen, Tianyin Elkholy, Shaimaa Xu, Meidong Zhong, Yunshi Zhang, Yiqun Chen, Weifeng Qin, Wenzheng Cai, Mingyan Zhou, Pinghong Gastric Peroral Endoscopic Myotomy (G-POEM) as a Treatment for Refractory Gastroparesis: Long-Term Outcomes |
title | Gastric Peroral Endoscopic Myotomy (G-POEM) as a Treatment for Refractory Gastroparesis: Long-Term Outcomes |
title_full | Gastric Peroral Endoscopic Myotomy (G-POEM) as a Treatment for Refractory Gastroparesis: Long-Term Outcomes |
title_fullStr | Gastric Peroral Endoscopic Myotomy (G-POEM) as a Treatment for Refractory Gastroparesis: Long-Term Outcomes |
title_full_unstemmed | Gastric Peroral Endoscopic Myotomy (G-POEM) as a Treatment for Refractory Gastroparesis: Long-Term Outcomes |
title_short | Gastric Peroral Endoscopic Myotomy (G-POEM) as a Treatment for Refractory Gastroparesis: Long-Term Outcomes |
title_sort | gastric peroral endoscopic myotomy (g-poem) as a treatment for refractory gastroparesis: long-term outcomes |
topic | Clinical Study |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6217887/ https://www.ncbi.nlm.nih.gov/pubmed/30425974 http://dx.doi.org/10.1155/2018/6409698 |
work_keys_str_mv | AT xujiaxin gastricperoralendoscopicmyotomygpoemasatreatmentforrefractorygastroparesislongtermoutcomes AT chentianyin gastricperoralendoscopicmyotomygpoemasatreatmentforrefractorygastroparesislongtermoutcomes AT elkholyshaimaa gastricperoralendoscopicmyotomygpoemasatreatmentforrefractorygastroparesislongtermoutcomes AT xumeidong gastricperoralendoscopicmyotomygpoemasatreatmentforrefractorygastroparesislongtermoutcomes AT zhongyunshi gastricperoralendoscopicmyotomygpoemasatreatmentforrefractorygastroparesislongtermoutcomes AT zhangyiqun gastricperoralendoscopicmyotomygpoemasatreatmentforrefractorygastroparesislongtermoutcomes AT chenweifeng gastricperoralendoscopicmyotomygpoemasatreatmentforrefractorygastroparesislongtermoutcomes AT qinwenzheng gastricperoralendoscopicmyotomygpoemasatreatmentforrefractorygastroparesislongtermoutcomes AT caimingyan gastricperoralendoscopicmyotomygpoemasatreatmentforrefractorygastroparesislongtermoutcomes AT zhoupinghong gastricperoralendoscopicmyotomygpoemasatreatmentforrefractorygastroparesislongtermoutcomes |