胃轻瘫是一种慢性和衰弱性胃肠病,几乎没有药物治疗选择。传统的外科治疗涉及腹腔镜幽门切开术或胃刺激。近年来,经口胃镜下肌切开术(GPOEM)已成为一种有吸引力的,难治性胃轻瘫患者的微创选择。关于GPOEM在难治性胃轻瘫患者中的长期临床成功的信息很少。本系统综述旨在评估该手术的长期临床疗效和安全性数据。在PubMed中进行了全面的文献综述,EMBASE,奥维德,和GoogleScholar数据库从2017年5月最早进入的日期到2022年8月15日。胃轻瘫躯体症状指数(GCSI)评分,不良反应,分析了住院时间。11项研究符合纳入条件(900名患者),其中七项研究是回顾性的,而四个是前瞻性的。GCSI是一种6点Likert量表问卷,用于评估胃轻瘫的改善情况。在一年的随访中,713名(92.8%)患者中的662名患者中,所有患者的GCSI平均比基线GCSI降低1分(描述为临床成功)。在两年的随访中,460人中有421人(91.5%),在三年随访中,270人中有270人(100%),在四年的随访中,102人中有102人(100%)。835例患者中有62例发生了不良事件(在9项研究中),最常见的两种是出血和粘膜撕裂。GPOEM是难治性胃轻瘫患者的有效和安全的治疗选择,术后4年症状改善。
Gastroparesis is a chronic and debilitating gastrointestinal disorder with few medical treatment options. Traditional surgical management has involved laparoscopic pyloromyotomy or gastric stimulation. In recent years, gastric peroral endoscopic myotomy (GPOEM) has become an attractive, less invasive option for patients with refractory gastroparesis. There is little information on the long-term clinical success of GPOEM in patients with refractory gastroparesis. This systematic
review aims to evaluate the data on this procedure\'s long-term clinical efficacy and safety. A comprehensive literature
review was done in PubMed, EMBASE, Ovid, and Google Scholar databases from the date of earliest entry in May 2017 up to August 15, 2022. The Gastroparesis Cardinal Symptom Index (
GCSI) score, adverse reaction, and length of stay were analyzed. Eleven studies were eligible for inclusion (900 patients), seven of the studies were retrospective, while four were prospective. The
GCSI is a 6-point Likert scale questionnaire that assesses improvement in gastroparesis. An average decrease of
GCSI by 1 point compared to baseline
GCSI for all patients (described as clinical success) was found in 662 patients out of 713 (92.8%) at one-year follow-up, 421 out of 460 (91.5%) at two-year follow-up, 270 out of 270 (100%) at three-year follow-up, and 102 out of 102 (100%) at four-year follow-up. Adverse events occurred in 62 out of 835 patients (in nine studies), with two of the most frequent being bleeding and mucosal tears. GPOEM is an effective and safe treatment option for patients with refractory gastroparesis, with symptom improvement noted up to four years postoperatively.