Abstract：
BACKGROUND: Pyloroplasty is an effective surgery for gastroparesis. However, some patients fail to improve after pyloric drainage and may require subsequent gastric electric stimulation. There is a paucity of data on the efficacy of gastric stimulator as an adjunct to failed pyloroplasty. This study aimed to describe our experience with pyloroplasty, determine the efficacy of gastric-stimulator for failed pyloroplasty, and compare the final outcomes of those who required pyloroplasty with and without gastric stimulator for gastroparesis.
METHODS: Records of patients who underwent primary pyloroplasty for gastroparesis at our institution were reviewed. Patients with poor symptomatic improvement after pyloroplasty underwent subsequent gastric-stimulator. Symptoms were assessed using the gastroparesis cardinal symptom index (GCSI) preoperatively and after each surgery. Severe gastroparesis was defined as GSCI total score ≥3. Outcomes were assessed after pyloroplasty in all patients and after stimulator in patients who failed pyloroplasty. Final outcomes were then compared between those who did and did not require adjunct gastric-stimulator.
RESULTS: The study population consisted of 104 patients (89.4% female) with a mean (SD) age of 42.2(11) and BMI of 26.9(7). Gastroparesis etiologies were 71.2% idiopathic, 17.3% diabetic, and 11.5% postsurgical. At 18.7(12) months after pyloroplasty there was a decrease in the GCSI total score [3.5(1) to 2.7(1.2), p=0.0012] and the rate of severe gastroparesis (71.9% to 29.3%, p<0.0001). Gastric emptying scintigraphy (GES) 4-hr retention decreased [36.5(24) to 15.3(18), p=0.0003]. Adjunct gastric-stimulator was required by 30 (28.8%) patients due to suboptimal outcomes with no improvement in GCSI (p=0.201) or GES (p=0.320). These patients were younger [40.5(10.6) vs 49.6(15.2), p=0.0016)], with higher baseline GSCI-Total scores [4.3(0.7)-vs-3.7(1.1), p<0.001] and more severe gastroparesis (100%-vs-55.6%, p<0.001). All other preoperative characteristics were similar. At 21.7(15) months after gastric-stimulator there was improvement in GCSI [4.1(0.7) to 2.6(1.1), p<0.0001], severe gastroparesis (100% to 33.3%, p<0.0001), and GES 4-hr retention [21.2(22) to 7.6(10), p=0.054]. Prior to gastric stimulator, those who failed pyloroplasty had significantly worse GCSI (p=0.0009) and GES (p=0.048). However, after gastric stimulator, GCSI and GES improved, and were comparable to those who only required pyloroplasty (p>0.05).
CONCLUSIONS: Pyloroplasty improved gastroparesis symptoms and gastric emptying, yet 28% failed, requiring gastric stimulator. Younger patients and those with preoperative GCSI scores ≥3 were more likely to fail. Gastric stimulator improved outcomes after failed pyloroplasty, with comparable final GCSI and GES to those who did not fail.
METHODS: Records of patients who underwent primary pyloroplasty for gastroparesis at our institution were reviewed. Patients with poor symptomatic improvement after pyloroplasty underwent subsequent gastric-stimulator. Symptoms were assessed using the gastroparesis cardinal symptom index (GCSI) preoperatively and after each surgery. Severe gastroparesis was defined as GSCI total score ≥3. Outcomes were assessed after pyloroplasty in all patients and after stimulator in patients who failed pyloroplasty. Final outcomes were then compared between those who did and did not require adjunct gastric-stimulator.
RESULTS: The study population consisted of 104 patients (89.4% female) with a mean (SD) age of 42.2(11) and BMI of 26.9(7). Gastroparesis etiologies were 71.2% idiopathic, 17.3% diabetic, and 11.5% postsurgical. At 18.7(12) months after pyloroplasty there was a decrease in the GCSI total score [3.5(1) to 2.7(1.2), p=0.0012] and the rate of severe gastroparesis (71.9% to 29.3%, p<0.0001). Gastric emptying scintigraphy (GES) 4-hr retention decreased [36.5(24) to 15.3(18), p=0.0003]. Adjunct gastric-stimulator was required by 30 (28.8%) patients due to suboptimal outcomes with no improvement in GCSI (p=0.201) or GES (p=0.320). These patients were younger [40.5(10.6) vs 49.6(15.2), p=0.0016)], with higher baseline GSCI-Total scores [4.3(0.7)-vs-3.7(1.1), p<0.001] and more severe gastroparesis (100%-vs-55.6%, p<0.001). All other preoperative characteristics were similar. At 21.7(15) months after gastric-stimulator there was improvement in GCSI [4.1(0.7) to 2.6(1.1), p<0.0001], severe gastroparesis (100% to 33.3%, p<0.0001), and GES 4-hr retention [21.2(22) to 7.6(10), p=0.054]. Prior to gastric stimulator, those who failed pyloroplasty had significantly worse GCSI (p=0.0009) and GES (p=0.048). However, after gastric stimulator, GCSI and GES improved, and were comparable to those who only required pyloroplasty (p>0.05).
CONCLUSIONS: Pyloroplasty improved gastroparesis symptoms and gastric emptying, yet 28% failed, requiring gastric stimulator. Younger patients and those with preoperative GCSI scores ≥3 were more likely to fail. Gastric stimulator improved outcomes after failed pyloroplasty, with comparable final GCSI and GES to those who did not fail.
摘要：
背景：幽门成形术是一种有效的胃轻瘫手术。然而,一些患者在幽门引流后无法改善，可能需要随后的胃电刺激。关于胃刺激器作为失败的幽门成形术的辅助手段的功效的数据很少。这项研究旨在描述我们的幽门成形术的经验，确定胃刺激器对失败的幽门成形术的疗效，并比较那些需要使用和不使用胃刺激器的幽门成形术治疗胃轻瘫的患者的最终结局。
方法：回顾了在我们机构接受原发性幽门成形术治疗胃轻瘫的患者的记录。幽门成形术后症状改善不良的患者随后接受了胃刺激器。术前和每次手术后使用胃轻瘫主要症状指数（GCSI）评估症状。严重胃轻瘫定义为GSCI总分≥3。在所有患者的幽门成形术后以及在幽门成形术失败的患者的刺激器后评估结果。然后比较那些需要和不需要辅助胃刺激器的患者的最终结果。
结果：研究人群包括104名患者（89.4％为女性），平均（SD）年龄为42.2（11），BMI为26.9（7）。胃轻瘫的病因为71.2%特发性，17.3%糖尿病患者,术后11.5%。在幽门成形术后18.7（12）个月，GCSI总分降低[3.5（1）至2.7（1.2），p=0.0012]和严重胃轻瘫的发生率（71.9％至29.3％，p<0.0001)。胃排空闪烁显像（GES）4小时保留减少[36.5（24）至15.3（18），p=0.0003]。30例（28.8％）患者需要辅助胃刺激器，因为结果欠佳，GCSI（p=0.201）或GES（p=0.320）没有改善。这些患者年龄较小[40.5（10.6）vs49.6（15.2），p=0.0016)],基线GSCI总分较高[4.3（0.7）-vs-3.7（1.1），p<0.001]和更严重的胃轻瘫（100％-vs-55.6％，p<0.001)。所有其他术前特征相似。在胃刺激器后21.7（15）个月，GCSI[4.1（0.7）至2.6（1.1），p<0.0001],重度胃轻瘫(100%至33.3%，p<0.0001),和GES4小时保留[21.2（22）至7.6（10），p=0.054]。在胃刺激器之前，幽门成形术失败的患者GCSI(p=0.0009)和GES(p=0.048)显著恶化.然而,在胃刺激器之后，GCSI和GES改进，与仅需要幽门成形术的患者相当(p>0.05)。
结论：幽门成形术可改善胃轻瘫症状和胃排空，然而28%的人失败了，需要胃刺激器.年轻患者和术前GCSI评分≥3的患者更有可能失败。胃刺激器可改善幽门成形术失败后的预后，与那些没有失败的人相比，最终的GCSI和GES。
方法：回顾了在我们机构接受原发性幽门成形术治疗胃轻瘫的患者的记录。幽门成形术后症状改善不良的患者随后接受了胃刺激器。术前和每次手术后使用胃轻瘫主要症状指数（GCSI）评估症状。严重胃轻瘫定义为GSCI总分≥3。在所有患者的幽门成形术后以及在幽门成形术失败的患者的刺激器后评估结果。然后比较那些需要和不需要辅助胃刺激器的患者的最终结果。
结果：研究人群包括104名患者（89.4％为女性），平均（SD）年龄为42.2（11），BMI为26.9（7）。胃轻瘫的病因为71.2%特发性，17.3%糖尿病患者,术后11.5%。在幽门成形术后18.7（12）个月，GCSI总分降低[3.5（1）至2.7（1.2），p=0.0012]和严重胃轻瘫的发生率（71.9％至29.3％，p<0.0001)。胃排空闪烁显像（GES）4小时保留减少[36.5（24）至15.3（18），p=0.0003]。30例（28.8％）患者需要辅助胃刺激器，因为结果欠佳，GCSI（p=0.201）或GES（p=0.320）没有改善。这些患者年龄较小[40.5（10.6）vs49.6（15.2），p=0.0016)],基线GSCI总分较高[4.3（0.7）-vs-3.7（1.1），p<0.001]和更严重的胃轻瘫（100％-vs-55.6％，p<0.001)。所有其他术前特征相似。在胃刺激器后21.7（15）个月，GCSI[4.1（0.7）至2.6（1.1），p<0.0001],重度胃轻瘫(100%至33.3%，p<0.0001),和GES4小时保留[21.2（22）至7.6（10），p=0.054]。在胃刺激器之前，幽门成形术失败的患者GCSI(p=0.0009)和GES(p=0.048)显著恶化.然而,在胃刺激器之后，GCSI和GES改进，与仅需要幽门成形术的患者相当(p>0.05)。
结论：幽门成形术可改善胃轻瘫症状和胃排空，然而28%的人失败了，需要胃刺激器.年轻患者和术前GCSI评分≥3的患者更有可能失败。胃刺激器可改善幽门成形术失败后的预后，与那些没有失败的人相比，最终的GCSI和GES。
