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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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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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Gastric per-oral endoscopic myotomy:Indications,technique,results and comparison with surgical approach

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World Journal of Gastrointestinal Surgery 2022年第1期14卷 12-23页

作者： Maria Chiara Verga Stefano Mazza Francesco Azzolini Fabrizio Cereatti Clara Benedetta Conti Andrea Drago Sara Soro Biagio Elvo Roberto Grassia Gastroenterology and Digestive Endoscopy Unit ASST CremonaCremona 26100Italy Gastroenterology and Digestive Endoscopy Unit Ospedale San Raffaele IRCCSMilano 20132Italy Digestive and Interventional Endoscopy Unit ASST MonzaMonza 20800Italy

Gastroparesis is a chronic disease of the stomach that causes a delayed gastric emptying,without the presence of a stenosis.For 30 years the authors identified pylorospasm as one of the most important pathophysiological mechanisms determining gastroparesis.Studies with EndoFLIP,a device that assesses pyloric distensibility,increased the knowledge about pylorospasm.Based on this data,several pyloric-targeted therapies were developed to treat refractory gastroparesis:Surgical pyloroplasty and endoscopic approach,such as pyloric injection of botulinum and pyloric stenting.Notwithstanding,the success of most of these techniques is still not complete.In 2013,the first human gastric per-oral endoscopic myotomy(GPOEM)was performed.It was inspired by the POEM technique,with a similar dissection method,that allows pyloromyotomy.Therapeutical results of GPOEM are similar to surgical approach in term of clinical success,adverse events and post-surgical pain.In the last 8 years GPOEM has gained the attention of the scientific community,as a minimally invasive technique with high rate of clinical success,quickly prevailing as a promising therapy for gastroparesis.Not surprisingly,in referral centers,its technical success rate is 100%.One of the main goals of recent studies is to identify those patients that will respond better to the therapies targeted on pylorus and to choose the better approach for each patient.

关键词： Gastric per-oral endoscopic myotomy Pyloroplasty Gastroparesis EndoFLIP pyloromyotomy Gastroparesis cardinal symptom index

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Gastric per-oral endoscopic myotomy: Current status and future directions

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World Journal of Gastroenterology 2019年第21期25卷 2581-2590页

作者： Alexander Podboy Joo Ha Hwang Linda A Nguyen Patricia Garcia Thomas A Zikos Afrin Kamal George Triadafilopoulos John O Clarke Division of Gastroenterology and Hepatology Stanford University School of Medicine

Gastroparesis, or symptomatic delayed gastric emptying in the absence of mechanical obstruction, is a challenging and increasingly identified syndrome. Medical options are limited and the only medication approved by the Food and Drug Administration for treatment of gastroparesis is metoclopramide, although other agents are frequently used off label. With this caveat, first-line treatments for gastroparesis include dietary modifications, antiemetics and promotility agents, although these therapies are limited by suboptimal efficacy and significant medication side effects. Treatment of patients that fail first-line treatments represents a significant therapeutic challenge. Recent advances in endoscopic techniques have led to the development of a promising novel endoscopic therapy for gastroparesis via endoscopic pyloromyotomy, also referred to as gastric per-oral endoscopic myotomy or per-oral endoscopic pyloromyotomy. The aim of this article is to review the technical aspects of the per-oral endoscopic myotomy procedure for the treatment of gastroparesis, provide an overview of the currently published literature, and outline potential next directions for the field.

关键词： Gastroparesis Gastric per-oral endoscopic myotomy Per-oral endoscopic pyloromyotomy Myotomy Endoscopic myotomy Peroral endoscopic myotomy Gastric emptying

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Double Incomplete pyloromyotomy (A. Ezzat Technique): A New Technique for Infantile Hypertrophic Pyloric Stenosis: Preliminary Study

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Open Journal of Pediatrics 2014年第4期4卷 253-256页

作者： Ahmed Ezzat Rozeik Radi Elsherbini Hamdi Almaramhy Pediatric Surgery Unit Zagazig University Al Sharqia Governorate Egypt Pediatric Surgery Unit Mansoura University Mansoura Egypt Faculty of Medicine Taibah University Medina KSA

Background-Purpose: The study aimed to see the outcome of Double Incomplete pyloromyotomy as new technique for surgical management of infantile hypertrophic pyloric stenosis (IHPS). Methods: This study was conducted in pediatric surgery unite, Zagazig University Hospital, Egypt. Fifteen patients were included in this study (11 male and 4 female) with IHPS from January 2012 to January 2013. Under general anesthesia, two longitudinal separated incisions at different planes as pyloromyotomy. Results: Postoperative vomiting and weight gain were recorded. Follow up period was 3 months. Vomiting improved within first 48 hours then stopped after that. Weight gain significantly increased after theoperation when compared preoperatively. Conclusion: Double Incomplete pyloromyotomy is a new, safe and effective procedure for treatment of infantile hypertrophic pyloric stenosis.

关键词： Hypertrophic Pyloric Stenosis Double Incomplete pyloromyotomy

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Do Immaturity, Dehydratation or Alkalosis Predispose to Intraoperative Complications at pyloromyotomy?

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Open Journal of Pediatrics 2016年第3期6卷 203-212页

作者： Ralf-Bodo Tröbs Lars Burghardt Micha Bahr Matthias Nissen Department of Pediatric Surgery Clinic Marien Hospital Herne St. Elisabeth Gruppe Ruhr-Universit?t Bochum Herne Germany

Background: Hypertrophic pyloric stenosis is the most important cause for propulsive non-bilious vomiting in infants of the first trimester. Extramucous splitting of the hypertrophic pyloric muscle is the surgical gold standard for treatment. Serious major complications of pyloromyotomy (PM) are mucosal perforation and incomplete muscle splitting. The aim of the presented study is to find out if intraoperative complications are predisposed by biometric or biochemical factors. Furthermore, we looked for the influence of the board certification of the primary surgeon. Patients and Methods: 162 infants with IHPS were operated during a six-year period (n = 150 laparoscopic operations). We had 8 major complications (4.9%): iatrogenic mucosal perforation occurred in 6 cases, and incomplete PM in 2 infants. Preoperative demographic data and data resulting from the blood acid-base- and ion-analysis were compared with data of a previously published reference group from our institution (Tr?bs RB. Open J Pediatr, 2014;4: 208-215). Results: The duration of vomiting, the grade of dehydration and the severity of blood alkalosis did not differ between both groups. Furthermore, we found no influence of the gestational age and birth weight on the occurrence of intraoperative complications. It seems that early postnatal age (p = 0.07) and low body weight at surgery (p = 0.055) may contribute to surgical problems. Board certification as a paediatric surgeon did not influence the rate of intraoperative complications. Conclusions: Laboratory data did not show any predisposition to intraoperative complications. It is assumed that small infants with early occurring symptoms carry an elevated risk for intraoperative events. Our data support the hypothesis that the rate of intraoperative complications at PM is mainly influenced by skills and experience of the surgeon.

关键词： Hypertrophic Pyloric Stenosis pyloromyotomy Complication Perforation Alkalosis Surgical Training

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Endoscopic treatment of gastroparesis

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World Journal of Gastroenterology 2015年第22期21卷 6842-6849页

作者： Thomas R McCarty Tarun Rustagi Department of Internal Medicine Yale University School of Medicine Section of Digestive Diseases Department of Internal Medicine Yale University School of Medicine

Gastroparesis has traditionally been a largely medically managed disease with refractory symptoms typically falling under the umbrella of the surgical domain.Surgical options include, but are not limited to, gastrostomy,jejunostomy, pyloromyotomy, or pyloroplasty,and the Food and Drug Administration approvedgastric electrical stimulation implantation. Endoscopic management of gastroparesis most commonly involves intrapyloric botulinum toxin injection; however, there exists a variety of endoscopic approaches on the horizon that have the potential to radically shift standard of care.Endoscopic management of gastroparesis seeks to treat delayed gastric emptying with a less invasive approach compared to the surgical approach. This review will serve to highlight such innovative and potentially transformative, endoscopic interventions available to gastroenterologists in the management of gastroparesis.

关键词： Botulinum Gastrojejunostomy Transpyloric pyloromyotomy Gastric stimulator Gastric pacemaker Stenting

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Single-site Umbilical Laparoscopic pyloromyotomy using a Pyloric Electrocoagulation Chisel Combined with a Left-handed Main Operation for congenital hypertrophic pyloric stenosis

Single-site Umbilical Laparoscopic Pyloromyotomy using a Pyl...

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2020年浙江省医学会小儿外科学术大会暨浙江省医师协会...

作者： Lin-Jun Yu Bao-Li Su Wang-Yong Shan Chun-Fen Luo Qiang Shu Department of Pediatric Surgery The Children's HospitalZhejiang University School of Medicine Department of Pediatric Surgery Zhejiang Taizhou Hospital Affiliated to Wenzhou Medical University

Background Laparoscopic pyloromyotomy has become a gold standard for the treatment of congenital hypertrophic pyloric stenosis.There have been recent reports on the use of transumbilical single-site laparoscopic surgery for congenital hypertrophic pyloric stenosis;however,use transumbilical single-site laparoscopic surgery in pediatric cases is still controversial due to the difficulty with manipulation.In this study,some preliminary experience with the application of a novel transumbilical single-site laparoscopic approach in congenital hypertrophic pyloric stenosis is described.Methods A retrospective study was conducted involving 25 patients with congenital hypertrophic pyloric stenosis treated in our hospital from August 2016 to August 2019.A pyloric electrocoagulation chisel combined with a left-handed main operation was completed in all of the patients and the operative times,post-operative length of stay,and operative complications were recorded.Results The laparoscopic operation was completed in 25 patients with an average operative time of 21.9±5.5 min,average post-operative length of stay of 2.5±0.9 days,and no perforations of the pyloric mucosa,recurrent obstruction,surgical incision infections,and incision hernias.All of the patients had at least 3 months of follow-up,good growth and development,and the parents were satisfied with the post-operative scars.Conclusions A pyloric electrocoagulation chisel combined with a left-handed main operation in the treatment of congenital hypertrophic pyloric stenosis by a single-site umbilical laparoscopic pyloromyotomy is safe and effective,and can achieve a satisfactory cosmetic effect.

关键词： Single-site umbilical laparoscopy pyloromyotomy hypertrophic pyloric stenosis pyloric electrocoagulation chisel left-handed main operation

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New insights on the pathogenesis of pyloric stenosis of infancy. A review with emphasis on the hyperacidity theory

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Open Journal of Pediatrics 2012年第2期2卷 97-105页

作者： Ian M. Rogers Surgery AIMST University Bedong Malaysia

A review is presented on the theories concerning the cause of pyloric stenosis with emphasis on the primary position of inherited hyperacidity in pathogenesis. Existing theories are critically analysed and the hyperacidity theory is precisely defined in the light of recent physiological insights into the gastrointestinal hormone motilin. The progressive fixed fasting hypergastrinaemia within the first few weeks of life will, in the baby who inherits acid secretion at the top of the normal range, produce hyperacidity of sufficient severity to trigger the process of acid-induced work hypertrophy of the pylorus. The potential contribution of motilin is discussed. The baby who inherits a normal gastric acidity will not reach acid levels severe enough to trigger sphincter hypertrophy despite the early gastrin stimulus. The potential threat will cease when gastrin naturally declines with age and the pyloric canal becomes wider. Genetic factors clearly must also be involved and these are separately discussed.

关键词： Infantile Hypertrophic Pyloric stenosis (IHPS) Immunohistochemistry Smooth Muscle Cells Gastrin Motilin Gastrointestinal Motility Erythromycin pyloromyotomy Acidification of the Stomach Pyloric Sphincter Function Receptor Binding Pathogenesis Antral Motility Gastric Outflow Obstruction Linkage Analysis Single Nucleotide Polymorphism: Interstitial Cells of Cahal Nitric Oxide Synthetase

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