Fluoroscopic gastric peroral endoscopic pyloromyotomy(G-POEM)in patients with a failed gastric electrical stimulator  

透视引导的内镜下幽门肌切开术(G-POEM)治疗胃电刺激无效的顽固性胃瘫

作　　者：Abhinav Koul Sunil Dacha Parit Mekaroonkamol Xiaoyu Li Lianyong Li Nikrad Shahnavaz Steven Keilin Field F.Willingham Jennifer Christie Qiang Cai 

机构地区：[1]Department of Gastroenterology,University of California Davis Medical Center,Sacramento,USA [2]Division of Digestive Diseases,Emory University School of Medicine,Atlanta,USA [3]Department of Gastroenterology,Qingdao University First Affiliated Hospital,Qingdao,China [4]Division of Digestive Diseases,PLA 306 Hospital,Beijing,China

出　　处：《Gastroenterology Report》2018年第2期122-126,I0002,共6页胃肠病学报道（英文）

摘　　要：Background:Gastric electrical stimulators(GESs)have been used to treat refractory gastroparesis in patients who fail initial therapies such as dietary modifications,control of psychological stressors and pharmacologic treatment.More recently,gastric peroral endoscopic pyloromyotomy(G-POEM)has emerged as a novel endoscopic technique to treat refractory gastroparesis.We present a case series of patients with refractory gastroparesis who failed treatment with an implanted GES that were safely treated with G-POEM performed under fluoroscopy as a salvage therapy.Methods:Cases of G-POEM performed on patients with refractory gastroparesis who failed treatment with a GES were retrospectively reviewed.All G-POEM procedures were performed under fluoroscopic guidance with the GES still in place.Gastroparesis Cardinal Symptoms Index(GCSI)and gastric emptying scintigraphy were assessed before and after the procedure.Patients were followed up for up to 18 months post procedure.Results:Five patients underwent G-POEM after failing treatment with a GES.Under fluoroscopy,the GES and their leads were visualized in different parts of the stomach.One GES lead was observed at the antrum near the myotomy site.All procedures were successfully completed without complications.Patients’GCSI decreased by an average of 62%1 month post procedure.Patients also had notable improvements in gastric emptying 2 months post procedure.Conclusion:In patients with refractory gastroparesis who have failed treatment with a GES,G-POEM can be safe and effective without removing the GES.To visualize the GES and avoid cutting GES leads during myotomy,the procedure should be performed under fluoroscopy.背景:胃电刺激可用于经饮食调节、压力疏导和药物治疗等初始治疗无效的顽固性胃瘫患者。最近,内镜下幽门肌切开术(G-POEM)成为了一种治疗顽固性胃瘫的新的内镜技术。本研究报道了一组经胃电刺激治疗无效、后经透视引导下G-POEM补救治疗成功治愈的顽固性胃瘫病例。方法:回顾性分析经胃电刺激治疗失败后接受G-POEM治疗的顽固性胃瘫患者的病历资料。所有G-POEM手术均在透视(了解胃电刺激器的安放位置)引导下进行。手术前后采用胃瘫主要症状指数(GCSI)和核素胃排空显像来评估胃动力。患者术后随访时间为1-18个月。结果:5例顽固性胃瘫患者在胃电刺激治疗失败后接受G-POEM治疗。透视下可见胃电刺激器及其导丝位于胃的不同部位,其中1例胃电刺激器位于胃窦接近幽门肌切开处。5例手术均顺利完成,未出现任何并发症。术后1个月,患者GCSI平均下降62%;术后2个月,患者胃排空情况显著改善。结论:对于胃电刺激治疗失败的顽固性胃瘫患者,G-POEM是一种安全有效的补充治疗措施,而且无需取出胃电刺激器。在幽门肌切开过程中,为了能观察到胃电刺激器的位置、避免切断胃电导线,G-POEM手术操作应在透视引导下进行。

关 键 词：GASTROPARESIS G-POEM PYLOROMYOTOMY gastric electrical stimulator FLUOROSCOPY 

分 类 号：R73[医药卫生—肿瘤]