| BackgroudGastroparesis is a clinical syndrome characterized by delayed gastric emptying,including nausea,vomiting,early satiety,abdominal pain and abdominal distension,which seriously affect the quality of life of patients.Various factors,such as diabetes,surgery,intestinal diseases,nervous system diseases,etc.,can lead to gastroparesis,and there are some idiopathic cases,of which the pathogenesis is not clear.In the past treatment of gastroparesis,drugs and physical therapy,gastric motility drugs,botulinum toxin injection,traditional Chinese medicine conditioning,and gastric electrical stimulation,for example,which can indeed improve the symptoms of patients to some extent,are the primary choices in the clinic.For patients with refractory gastroparesis,that is,patients with severe symptoms,significantly lower quality of life,ineffective conventional treatment or recurrence after clinical symptoms have improved,safe and effective treatments are still being exploring.It has been observed that most patients with gastroparesis have a pyloric spasm during endoscopy,leading to endoscopic difficulty through the pylorus,based on which it could be considered treating gastroparesis by relieving the pyloric spasm.Surgical interventions,such as laparoscopic pyeloplasty,have been proposed as an effective treatment for the refractory gastroparesis.Inspired by pyloric angioplasty and Per-oral endoscopic myotomy(POEM)for the treatment of achalasia,Gastric per-oral endoscopic pyloromyotomy(G-POEM)has been gradually developed for clinical use.There are few clinical observations about G-POEM treatment for different types of gastroparesis.Since the first G-POEM for the treatment of gastroparesis in 2013,compared with traditional treatment,it has been experimentally developed worldwide because of its good curative effect,low cost and small trauma.However,due to the deep-rooted conventional treatment,there are not many research cases around the world,which makes more specific surgical details and treatment plans to be further explored.ObjectiveTo evaluate the short-term efficacy and safety of Gastric per-oral endoscopic myotomy(G-POEM)in the treatment of refractory gastroparesis.MethodsWe retrospectively analyzed 6 patients with refractory gastroparesis treated by G-POEM in the Department of Gastroenterology,the First Affiliated Hospital of Zhengzhou University from March 2017 to March 2018.Perioperative complications and its prevalence,.The severity of symptoms before and after surgery was evaluated,and the improvement of symptoms was confirmed by comparison.ResultsThe G-POEM procedure was successful in 6 patients,with an average operative time of 39.50±8.17 min and an average circular muscle incision length of 2.27±0.29 cm.The mean GCSI(Gastroparesis cardinal symptom index)scores of the 6 patients decreased from 3.50 ± 0.65 preoperatively to 0.73 ± 0.15 at 3 days postoperatively,and the difference was statistically significant(t=9.221,P<0.01).Six patients had no serious complications such as perforation and shock during operation;one patient had a small amount of bleeding during operation,and hemorrhage was stopped after hemostasis was stopped.One patient developed fever after surgery,and the body temperature returned to normal after antibiotic application.During the follow-up,the symptoms of the 5 patients were significantly improved.The gastroscopy showed that the wound healing well,and the pyloric resistance was significantly lower than before.The GES(Gastric emptying scan)4h was <10%.One patient with diabetes mellitus experienced symptoms of nausea,vomiting and abdominal pain again after 3 months.A review of the gastroscope revealed a large amount of stagnation in the stomach,and the pyloric resistance was large.The GES4 h was 55%(70% before surgery).ConclusionG-POEM is a short-term treatment for refractory gastroparesis,which can improve symptoms and gastric emptying function.It can be used as an important choice for the treatment of gastroparesis. |
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