Outcomes and quality-of-life assessment after gastric per-oral endoscopic pyloromyotomy (with video)

Dacha, Sunil; Mekaroonkamol, Parit; Li, Lianyong; Shahnavaz, Nikrad; Sakaria, Sonali; Keilin, Steven; Willingham, Field F.; Christie, Jennifer; Cai, Qiang

doi:10.1016/j.gie.2017.01.031

Cited by 118 publications

(129 citation statements)

References 25 publications

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“…Among the 10 studies included in this meta-analysis, four were prospective [19][20][21][22], including two published abstracts [20,21], and 6 were retrospective [1,[23][24][25][26][27], including also another abstract [27], which we chose instead of the published article from the same group, because it is more recent and has a larger number of patients [28]. In total, 281 patients were included in this meta-analysis.…”

Section: Study Characteristics and Quality Assessmentmentioning

confidence: 99%

“…Using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Series quality assessment, all 10 studies did not clearly report the demographics of the participants. Five studies did not report clear information about the participants [20][21][22][23]27] and two were unclear [25,26] The Hustak et al [20] study was the only one that did not report clear information about the site/clinic demographic information. Quality assessment is shown in ▶ Table 2.…”

Section: Study Characteristics and Quality Assessmentmentioning

confidence: 99%

“…Although the hetero-geneity was high, all the studies showed improvement in the GCSI score after the procedure. Four studies completed 6 months of follow up [20,27], two studies completed 12 months [20,27], and one study 18 months [23] following the procedure. These studies showed a decrease in the values of GSCI after G-POEM, and the overall mean difference for the GCSI subgroup was 1.84 [1.57-2.12] with a 95 % confidence interval by the Cochrane Q test (P < 0.0001; I 2 = 71 %) (▶ Fig.…”

Section: Gcsi Subgroupmentioning

confidence: 99%

“…7). However, the follow-up duration was quite heterogeneous across all studies, varying from 1 to 24 months; therefore, we calculated the clinical success rate with the longest follow-up data available provided in seven studies [20][21][22][23][24][25]27]. We included one published abstract in this meta-analysis, from Hustak et al [20], that has the longest follow-up period, where one woman from a total of seven patients included had finished the 24-month follow up and maintained an excellent outcome (mean GCSI: 0.77).…”

Section: Certainty Assessmentmentioning

confidence: 99%

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Peroral endoscopic pyloromyotomy for gastroparesis: a systematic review and meta-analysis

et al. 2020

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Background and aim Gastric peroral endoscopic pyloromyotomy (G-POEM) is a new therapeutic option for refractory gastroparesis (GP). A systematic review and meta-analysis was conducted to assess the effectiveness of G-POEM in refractory GP. For the quality of evidence, we used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Methods We performed a literature search using MEDLINE, Embase, Cochrane library, LILACS and the Science citation index for studies related to G-POEM from the inception of its technique through January 2019. We selected studies that analyzed the gastroparesis cardinal symptom index (GCSI) and 4-hour solid-phase gastric emptying scintigraphy (GES) before and after the procedure to verify the efficacy of G-POEM, the main outcome measured. An analysis was performed using RevMan 5.3. Results Ten studies comprising 281 patients were included in this systematic review. The pooled mean difference in GCSI following the procedure was 1.76 (95 % CI: [1.43, 2.08], I2 = 72 %). We also performed GCSI subgroup analysis by follow-up duration that showed a pooled mean difference of 1.84 (95 % CI: [1.57, 2.12], I2 = 71 %). The pooled mean difference in GES after the procedure was 26.28 (95 % CI: [19.74, 32.83], I2 = 87 %), corresponding to a significant drop in percentage values of the gastric retention 4-hour scintigraphy. Conclusion This meta-analysis demonstrates that G-POEM is effective and shows promising outcomes in the clinical response and gastric emptying scintigraphy for gastroparesis. Therefore, it should be considered in the management of refractory gastroparesis.

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Section: Study Characteristics and Quality Assessmentmentioning

confidence: 99%

Section: Study Characteristics and Quality Assessmentmentioning

confidence: 99%

Section: Gcsi Subgroupmentioning

confidence: 99%

Section: Certainty Assessmentmentioning

confidence: 99%

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Peroral endoscopic pyloromyotomy for gastroparesis: a systematic review and meta-analysis

et al. 2020

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“…30 An additional factor is the emergence of pyloric therapies for gastroparesis over the last 5 years. 31,32 Although not yet defined, the presence of systemic inflammation might indicate that the occurrence of pyloric dysfunction, including fibrosis, and resultant delayed gastric emptying, might be a secondary consequence of inflammation at the local GI tract level.…”

Section: Anatomic-mucosal Neuronal Density Vs Full-thickness Biopsymentioning

confidence: 99%

Gastroparesis syndromes: Response to electrical stimulation

Abell

Kedar

Stocker

et al. 2019

Neurogastroenterology Motil

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Background and Aims Factors underlying gastroparesis are not well defined, nor is the mechanism of action of gastric electrical stimulation (GES). We hypothesized that GES acts via several mechanisms related to underlying disordered pathophysiology. Methods We studied 43 consecutive eligible patients with gastroparetic symptoms, previously evaluated by two methods in each of five core areas: inflammatory, autonomic, enteric, electrophysiologic, and hormonal; and also categorized by GI symptoms, metabolic status, illness quantification, and gastric physiology. We then studied 41 patients who underwent temporary GES for 5‐7 days. Thirty‐six of those patients were implanted and 30 were followed up at 6 months after permanent GES. Results In previous but separately reported work, patients had similar GI symptoms regardless of baseline gastric emptying or diabetic/idiopathic status and all patients demonstrated abnormalities in each of the five areas studied. After GES, patients showed early and late effects of electrical stimulation with changes noted in multiple areas, categorized by improvement status. Conclusion Patients with symptoms of gastroparesis have multiple abnormalities, including systemic inflammation and disordered hormonal status. GES affects many of these abnormalities. We conclude electrical stimulation improves symptoms and physiology with (a) an early and sustained anti‐emetic effect; (b) an early and durable gastric prokinetic effect in delayed emptying patients; (c) an early anti‐arrhythmic effect that continues over time; (d) a late autonomic effect; (e) a late hormonal effect; (f) an early anti‐inflammatory effect that persists; and (g) an early and sustained improvement in health‐related quality of life. This study is registered with Clinicaltrials.gov under study # NCT03178370 (https://clinicaltrials.gov/ct2/show/NCT03178370).

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Safety and performance of the HYBRIDknife flex in a porcine model of esophageal endoscopic submucosal dissection: A pilot study

Khor,

Ichimasa,

Tsao

et al. 2024

JGH Open

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Background and AimEndoscopic submucosal dissection (ESD) is considered the best modality for achieving en bloc resection of larger neoplastic mucosal lesions in the upper and lower gastrointestinal (GI) tract. Multiple devices are available for ESD, and refinements continue to be made to develop devices that improve the safety and efficiency of performing ESD. Submucosal injection with viscous fluids like glycerol, which prolong submucosal expansion, could facilitate the procedure. We aimed to evaluate the safety and performance of the new Erbe HYBRIDknife® flex, which combines electrosurgical dissection with waterjet‐assisted injection in a slim and flexible form factor.MethodsIn a prospective animal study with six pigs, four endoscopists, each with 10–20 years of experience in ESD, performed 28 esophageal ESDs. One half was performed with physiological saline injectate, the other half with fructose‐added glycerol. Various performance aspects were evaluated on a five‐point scale [5 = best], including dissection properties, handling, and usability.ResultsNo perforations or major bleeding occurred. All resections were performed en bloc, with one technical failure (3.6%, 1 of 28). Performance scores were similar for saline and glycerol (4.5 ± 0.31 vs. 4.5 ± 0.32, P = 0.36), as was dissection speed (13 ± 6.2 mm2/min vs. 15 ± 6.1 mm2/min, P = 0.22).ConclusionsWe demonstrated that esophageal ESD can be performed safely and rapidly using HYBRIDknife flex, with excellent performance evaluation by the endoscopists. Combining this device with glycerol or saline is precise and effective for ESD, although experience could compensate for the theoretical disadvantage of using normal saline.

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Outcomes and quality-of-life assessment after gastric per-oral endoscopic pyloromyotomy (with video)

Abstract: GPOEM results in improvement in the overall symptoms of gastroparesis measured by GCSI, objective assessment of improvement in gastric emptying, and improvement in multiple domains on validated quality-of-life inventories in SF36 over a follow-up period of 6 months.

Cited by 118 publications

References 25 publications

Peroral endoscopic pyloromyotomy for gastroparesis: a systematic review and meta-analysis

Peroral endoscopic pyloromyotomy for gastroparesis: a systematic review and meta-analysis

Gastroparesis syndromes: Response to electrical stimulation

Safety and performance of the HYBRIDknife flex in a porcine model of esophageal endoscopic submucosal dissection: A pilot study

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