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Safety and feasibility of same day discharge after per oral endoscopic pyloromyotomy in refractory Gastroparesis: a pilot study

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Chinese Medical Journal 2022年第12期135卷 1432-1437页

作者： Rushikesh Shah Huimin Chen Lucie F.Calderon Tonia Gooden Maryam Mubashir Shazia Rashid Syed Musa Raza Allison Derise Grace Mccurdy Brenna Sanders Steve Keilin Qiang Cai Division of Digestive Diseases Emory University School of MedicineAtlantaGAUSA Division of Gastroenterology and Hepatology Shanghai nsitute of Digestive DiseaseRenj HospitalShanghai JjaoTong University School of MedicineShanghai 200127China Division of Gastroenterology and Hepatology Louisiana State UniversitShreveportLAUSA

Background:Gastroparesis is a debilitating medical condition with limited treatment options.Gastric per-oral pyloromyotomy(G-POEM)has emerged as a promising treatment option with remarkable short-term clinical success shown in multiple studies.While the post-procedure protocol is not standardized across many centers,the majority of the centers observes these patients in the hospital after the procedure for monitoring.In this single-center prospective study,we evaluated the safety and feasibility of same day discharge after the G-POEM procedure.Methods:All the patients with refractory Gastroparesis undergoing G-POEM from October 2019 to March 2020 were enrolled.A total of 25 patients were enrolled in the procedure.Based on the pre-defined criteria,patients were either discharged on the same day after the procedure or admitted to the hospital for further observation.The patient and procedure-related data were extracted from the chart review.Univariate analysis was performed(chi-squared test)on categorical variables after organizing categorical variables as numeric counts or percentages.The student t test was performed on continuous variables after reporting as mean and standard deviation.For analysis with a smaller sample size,Fisher exact and Mann–Whitney tests were used.Results:A total of 25 patients were enrolled.The technical success of G-POEM was 100%and clinical success was 80%(20/25)at 1-month follow-up.Of the 25 patients,9 patients(36%)were discharged on the same day according to the procedure from the recovery unit.Of the remaining 16 patients who were admitted to the hospital post-procedure,10(40%)were admitted due to procedure-related causes while other admissions were either pre-planned or due to social reasons.The average Charlson comorbidity index was lower in the same day discharge group(P<0.05).The number of patients requiring double myotomy was higher in the same day discharge group(P<0.05).The overall complication rate of G-POEM in the study cohort was 12%(3/25)with all complications being mild wi

关键词： G-POEM Pyloromyotomy Gastroparesis Gastric per-oral pyloromyotomy

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Gastroparesis:New insights into an old disease

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World Journal of Gastroenterology 2020年第19期26卷 2333-2348页

作者： Paolo Usai-Satta Massimo Bellini Olivia Morelli Francesca Geri Mariantonia Lai Gabrio Bassotti Department of Internal Medicine Division of GastroenterologyBrotzu HospitalCagliari 09124Italy Gastrointestinal Unit Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of PisaPisa 56122Italy Gastroenterology and Hepatology Section Department of MedicineUniversity of Perugia Medical SchoolPerugia 06123Italy Gastroenterology Unit University of CagliariMonserrato 09042Italy

Gastroparesis(Gp)is a chronic disease characterized by a delayed gastric emptying in the absence of mechanical obstruction.Although this condition has been reported in the literature since the mid-1900s,only recently has there been renewed clinical and scientific interest in this disease,which has a potentially great impact on the quality of life.The aim of this review is to explore the pathophysiological,diagnostic and therapeutical aspects of Gp according to the most recent evidence.A comprehensive online search for Gp was carried out using MEDLINE and EMBASE.Gp is the result of neuromuscular abnormalities of the gastric motor function.There is evidence that patients with idiopathic and diabetic Gp may display a reduction in nitrergic inhibitory neurons and in interstitial cells of Cajal and/or telocytes.As regards diagnostic approach,99-Technetium scintigraphy is currently considered to be the gold standard for Gp.Its limits are a lack of standardization and a mild risk of radiation exposure.The C13 breath testing is a valid and safe alternative method.13C acid octanoic and the 13C Spirulina platensis recently approved by the Food and Drug Administration are the most commonly used diagnostic kits.The wireless motility capsule is a promising technique,but its use is limited by costs and scarce availability in many countries.Finally,therapeutic strategies are related to the clinical severity of Gp.In mild and moderate Gp,dietary modification and prokinetic agents are generally sufficient.Metoclopramide is the only drug approved by the Food and Drug Administration for Gp.However,other older and new prokinetics and antiemetics can be considered.As a second-line therapy,tricyclic antidepressants and cannabinoids have been proposed.In severe cases the normal nutritional approach can be compromised and artificial nutrition may be needed.In drug-unresponsive Gp patients some alternative strategies(endoscopic,electric stimulation or surgery)are available.

关键词： Gastroparesis Delayed gastric emptying Gastric Scintigraphy 13C breath testing Wireless motility capsule Prokinetics Antiemetic drugs Gastric-per-oral endoscopic myotomy Gastric electrical stimulation

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Gastric electrical stimulation: An emerging therapy for children with intractable Gastroparesis

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World Journal of Gastroenterology 2019年第48期25卷 6880-6889页

作者： Aniruddh Setya Priyanka Nair Sam Xianjun Cheng Department of Pediatric Gastroenterology Hepatology and Nutrition University of Florida

Management of Gastroparesis remains challenging,particularly in pediatric patients.Supportive care and pharmacological therapies for symptoms remain the mainstay treatment.Although they are effective for mild and some moderately severe cases,often time they do not work for severe Gastroparesis.There are a few prokinetics available,yet the use of these drugs is limited by a lack of persistent efficacy and/or safety concerns.Currently,the only modality for adult patients with severe intractable Gastroparesis is surgery,e.g.,pyloroplasty and partial gastrectomy,however,this option is generally considered too radical for a growing child.Novel therapeutic approaches,particularly those which are less invasive,are needed.This article explores gastric electrical stimulation(GES),a new therapy for Gastroparesis.Unlike others,it neither needs medications nor gastrectomy;rather,it treats through the use of microelectrodes to deliver high-frequency low energy electric stimulation to the pacemaker area of the stomach.Thus,it is tolerated and safe in children.Like in adult patients,GES appears to work in releasing symptoms,improving nutrition,and enhancing the quality of life;it also helps wean off medications and eliminate many needs for hospitalization.Considering the transient nature of Gastroparesis in children in many occasions,GES is considered a“bridging”therapy after failed medical interventions and before surgery.

关键词： Gastroparesis Gastric electrical stimulation Nausea Vomiting Prokinetics

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Chronic opioids in Gastroparesis: relationship with gastrointestinal symptoms, healthcare utilization and employment

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World Journal of Gastroenterology 2017年第40期23卷 7310-7320页

作者： Asad Jehangir Henry P Parkman Department of Internal Medicine Reading Health System Department of Gastro-enterology Temple University Hospital

AIM To examine the relationship of chronic scheduled opioid use on symptoms, healthcare utilization and employment in Gastroparesis(Gp) patients. Methods Patients referred to our tertiary care academic center from May 2016 to July 2017, with established diagnosis or symptoms suggestive of Gp filled out the Patient Assessment of Upper GI Symptoms, abdominal pain and demographics questionnaires, and underwent gastric emptying and blood tests. They were asked about taking pain medicines and the types, doses, and duration. We used Mann Whitney U test, Analysis of Variance, Student's t test and χ2 tests where appropriate for data analyses.RESULTS Of 223 patients with delayed gastric emptying, 158(70.9%) patients were not taking opioids(Gp NO), 22(9.9%) were taking opioids only as needed, while 43(19.3%) were on chronic(> 1 mo) scheduled opioids(Gp CO), of which 18 were taking opioids forreasons that included Gastroparesis and/or stomach pain. Median morphine equivalent use was 60 mg per day. Gp CO reported higher severities of many gastrointestinal symptoms compared to Gp NO including nausea(mean ± SE of mean of 4.09 ± 0.12 vs 3.41 ± 0.12, P = 0.011), retching(2.86 ± 0.25 vs 1.98 ± 0.14, P = 0.003), vomiting(2.93 ± 0.24 vs 2.07 ± 0.15, P = 0.011), early satiety(4.17 ± 0.19 vs 3.57 ± 0.12, P = 0.004), post-prandial fullness(4.14 ± 0.18 vs 3.63 ± 0.11, P = 0.022), loss of appetite(3.64 ± 0.21 vs 3.04 ± 0.13, P = 0.039), upper abdominal pain(3.86 ± 0.20 vs 2.93 ± 0.13, P = 0.001), upper abdominal discomfort(3.74 ± 0.19 vs 3.09 ± 0.13, P = 0.031), heartburn during day(2.55 ± 0.27 vs 1.89 ± 0.13, P = 0.032), heartburn on lying down(2.76 ± 0.28 vs 1.94 ± 0.14, P = 0.008), chest discomfort during day(2.42 ± 0.20 vs 1.83 ± 0.12, P = 0.018), chest discomfort at night(2.40 ± 0.23 vs 1.61 ± 0.13, P = 0.003), regurgitation/reflux during day(2.77 ± 0.25 vs 2.18 ± 0.13, P = 0.040) and bitter/acid/sour taste in the mouth(2.79 ± 0.27 vs 2.11 ± 0.14, P = 0.028). Gp CO had a longer duration of nausea per day(median of 7 h vs 4 h for Gp

关键词： Opioid Gastroparesis Symptoms Hospitalizations Employment

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Psychological controversies in Gastroparesis: A systematic review

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World Journal of Gastroenterology 2017年第7期23卷 1298-1309页

作者： Sally Woodhouse Geoff Hebbard Simon R Knowles Department of Psychological Sciences Swinburne University of Technology Department of Gastro-enterology the Royal Melbourne Hospital Department of Medicine University of Melbourne Department of Psychiatry St Vincent’s Hospital

AIM To systematically review literature addressing three key psychologically-oriented controversies associated with Gastroparesis. METHODS A comprehensive search of Pub Med, CINAHL, and PsycI NFO databases was performed to identify literature addressing the relationship between Gastroparesis and psychological factors. Two researchers independently screened all references. Inclusion criteria were: an adult sample of Gastroparesis patients, a quantitative methodology, and at least one of the following:(1) evaluation of the prevalence of psychopathology;(2) an outcome measure of anxiety, depression, or quality of life; and(3) evidence of a psychological intervention. Case studies, review articles, and publications in languages other than English were excluded from the current review. RESULTS Prevalence of psychopathology was evaluated by three studies(n = 378), which found that combined anxiety/depression was present in 24% of the Gastroparesis cohort, severe anxiety in 12.4%, depression in 21.8%-23%, and somatization in 50%. Level of anxiety and depression was included as an outcome measure in six studies(n = 1408), and while limited research made it difficult to determine the level of anxiety and depression in the cohort, a clear positive relationship with Gastroparesis symptom severity was evident.Quality of life was included as an outcome measure in 11 studies(n = 2076), with Gastroparesis patients reporting lower quality of life than population norms, and a negative relationship between quality of life and symptom severity. One study assessed the use of a psychological intervention for Gastroparesis patients(n = 120) and found that depression and gastric function were improved in patients who received psychological intervention, however the study had considerable methodological limitations. CONCLUSION Gastroparesis is associated with significant psychological distress and poor quality of life. Recommendations for future studies and the development of psychological interventions are provided.

关键词：焦虑消沉 Gastroparesis 生活的质量心理悲痛

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Acute opioid-induced Gastroparesis successfully treated with naloxone: a case report

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Emergency and Critical Care Medicine 2023年第2期3卷 78-80页

作者： Hao Rui Seet Joe-Anthony Rotella Department of Emergency Medicine Northern HealthEppingVictoriaAustralia

A 56-year-old man presented to the emergency department after an intentional overdose of oxycodone and ethanol.He was previously opioid-naive with no other medical history.He subsequently developed acute abdominal pain with nausea and vomiting.A computed tomography scan of his abdomen and pelvis revealed distension of his stomach with no other abnormalities suggestive Gastroparesis.He was subsequently treated with intravenous naloxone with complete resolution of his symptoms soon after.This case highlights the association between opioids and acute gastrointestinal mobility disorders contrary to the traditional association with chronic opioid use,as well as the utility of naloxone as a treatment.

关键词： Case report Gastroparesis Naloxone Opioids

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Influence of Musa Sapientum L. on Pharmacokinetic of Metformin in Diabetic Gastroparesis

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Chinese Journal of Integrative Medicine 2016年第10期22卷 783-788页

作者： Vaibhav Darvhekar Alok Shiomurti Tripathi Shriramji G.Jyotishi Papiya Mitra Mazumder Pradeep G.Shelke Department of Pharmacognosy P.Wadhwani College of Pharmacy Department of Pharmacology P.Wadhwani College of Pharmacy Shree Ayurvedic College Hanuman Nagar Department of Pharmaceutical Sciences Birla Institute of Technology Department of Pharmaceutical Chemistry P. Wadhwani College of Pharmacy

Objective： To investigate the effect of Musa sapientum L. （MS） bark juice in diabetic Gastroparesis and its effect on pharrnacokinetic of metformin （MET）. Methods： Diabetes was induced in rats by administering alloxan （120 mg/kg） saline solution and maintained for 8 week. All the 18 Sprague-Dawley rats were divided into three groups （n=6 in each group）： normal control, diabetic control and MS bark juice. Assessment of diabetes was done by glucose oxidase-peroxidase method on the 3rd day of alloxan administration. The effects of MS bark juice （100 mL/kg） on gastric emptying time, intestinal transit time, contractility of fundus and pylorus as well as gastdc acid secretion in chronic diabetic rats were observed after 8 weeks of aUoxan administration. The effect of MS bark juice on the pharmacokinetic of orally administered single dose of MET （350 mg/kg） was evaluated on the 57th day of protocol. Any drugs that may reduce the blood glucose level or influence the fibrinolytic system were not used in this study. Results： The MS bark juice significantly reduced the blood glucose level in the diabetic rats （P〈0.01）. There was significant decrease in the pylorus motility and increase in the gastric emptying time, intestinal transit time, contractility of fundus, gastric acid secretion in the MS bark juice treated group （P〈0.01）. There was significant decrease in the time at which drug at a maximum concentration, haft life of drug and increase in the maximum concentration of drug in the plasma of MET in MS bark juice treated group as compared to diabetic control group （P〈0.01）. Conclusion： MS bark juice effectively manages diabetic Gastroparesis and thereby improves the bioavailabilty of MET when administered with MS bark iuice.

关键词： Gastroparesis metformin Musa sapientum L. gastdc emptying time intestinal transit time

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Implication of neurohormonal-coupled mechanisms of gastric emptying and pancreatic secretory function in diabetic Gastroparesis

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World Journal of Gastroenterology 2018年第34期24卷 3821-3833页

作者： Bashair M Mussa Sanjay Sood Anthony JM Verberne Department of Basic Medical Science College of Medicine University of Sharjah Department of Medicine Austin HealthUniversity of Melbourne

Recently, diabetic Gastroparesis(DGP) has received much attention as its prevalence is increasing in a dramatic fashion and management of patients with DGP represents a challenge in the clinical practice due to the limited therapeutic options. DGP highlights an interrelationship between the gastric emptying and pancreatic secretory function that regulate a wide range of digestive and metabolic functions, respectively. It well documented that both gastric emptying and pancreatic secretion are under delicate control by multiple neurohormonal mechanisms including extrinsic parasympathetic pathways and gastrointestinal(GI) hormones. Interestingly, the latter released in response to various determinants that related to the rate and quality of gastric emptying. Others and we have provided strong evidence that the central autonomic nuclei send a dual output(excitatory and inhibitory) to the stomach and the pancreas in response to a variety of hormonal signals from the abdominal viscera. Most of these hormones released upon gastric emptying to provide feedback, and control this process and simultaneously regulate pancreatic secretion and postprandial glycemia. These findings emphasize an important link between gastric emptying and pancreatic secretion and its role in maintaining homeostatic processes within the GI tract. The present review deals with the neurohormonal-coupled mechanisms of gastric emptying and pancreatic secretory function that implicated in DGP and this provides new insights in our understanding of the pathophysiology of DGP. This also enhances the process of identifying potential therapeutic targets to treat DGP and limit the complications of current management practices.

关键词： Gastroparesis Gastric emptying Pancreatic secretion Postprandial glycemia Neurohormonal control

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Outcomes of per oral endoscopic pyloromyotomy in Gastroparesis worldwide

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World Journal of Gastroenterology 2019年第8期25卷 909-922页

作者： Parit Mekaroonkamol Rushikesh Shah Qiang Cai Division of Digestive Diseases Emory University School of Medicine

Per oral endoscopic pyloromyotomy(POP),also known as gastric per-oral endoscopic myotomy(GPOEM),is a novel procedure with promising potential for the treatment of Gastroparesis.As more data emerge and the procedure is becoming more recognized in clinical practice,its safety and efficacy need to be carefully evaluated.Appropriate patient selection for favorable clinical success prediction after GPOEM also needs additional research.This review aims to systemically summarize the existing data on clinical outcomes of POP.Symptomatologic responses to the procedure,its adverse effects,procedural techniques,and predictive factors of clinical success are also discussed.

关键词： Gastroparesis Per oral endoscopic pyloromyotomy Gastric per-oral endoscopic myotomy Pyloromyotomy Outcomes

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功能性消化不良和胃轻瘫的病理生理学和治疗新进展

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中华消化杂志 2021年第1期41卷 3-15页

作者：陈建德成家飞密歇根大学医学院消化科美国密西根州安娜堡市江苏省中医院消化科南京210029

Functional dyspepsia(FD)and Gastroparesis are two common functional gastrointestinal diseases,affecting millions of people in both China and around the world.However,treatment options are limited and difficult due to multiple factors involved in their pathophysiologies.Therefore it is critically important to assess and understand pathophysiologies of these diseases before a treatment is given.In this minireview we provide updates on recent development in the pathophysiologies and treatments of FD and Gastroparesis.In addition to common abnormalities in gastric accommodation,antral hypomotility and visceral hypersensitivity,FD has recently been reported to display a number of impairment in duodenal functions,such as low-grade inflammation and increased permeability.For Gastroparesis,macrophages have recently been reported to play an important role in its pathophysiology.A brief overview on the assessment of pathophysiologies of FD and Gastroparesis is also provided;pros and cons of clinically available methodologies as well as emerging methods are discussed.Finally,available treatment options for FD and Gastroparesis are presented in this minireview,including authors′opinions on the advantages and disadvantages of each therapy.Potential novel therapies for FD and Gastroparesis,especially those associated with Traditional Chinese Medicine,are also introduced and discussed.

关键词： Functional dyspepsia Gastroparesis Gastrointestinal motility Neuromodulation Alternative medicine

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