经口内镜下幽门肌切开术治疗难治性胃轻瘫的研究进展

胃轻瘫的发病率日益增加,其治疗方式主要有药物保守治疗、胃电刺激、幽门成形术、肉毒杆菌毒素注射和幽门支架置入术。经口内镜下幽门肌切开术（G-POEM）是治疗难治性胃轻瘫的一种较新的术式,具有微创、安全、有效等优势,本文就G-POEM治疗难治性胃轻瘫的研究进展作一综述。     

经口内镜下幽门肌切开术治疗保留幽门中段胃切除术后迟发性胃轻瘫1例

术后胃轻瘫是保留幽门胃切除术后常见并发症之一,严重影响患者的生活质量。本文报道1例早期胃癌患者行机器人辅助保留幽门中段胃切除术,半年后因胃排空障碍再次入院,经多种保守治疗手段治疗无效,行经口内镜下幽门肌切开术治疗。     

经口内镜下幽门肌切开术治疗难治性胃轻瘫的疗效观察

目的 评价经口内镜下幽门肌切开术（G-POEM）治疗难治性胃轻瘫的短期疗效及安全性。方法 回顾性分析2017年3月至2018年3月于郑州大学第一附属医院消化内科行G-POEM治疗的6例难治性胃轻瘫患者资料，其中3例糖尿病胃轻瘫，1例近端胃切除术后胃轻瘫，2例特发性胃轻瘫。评估手术情况、并发症发生情况，及手术前后胃轻瘫主要症状指数（GCSI）和胃排空显像（GES）变化。结果 6例患者G-POEM过程顺利，平均手术时间39.5 min，平均环形肌切开长度2.3 cm。平均GCSI评分由术前的3.50分降至术后3 d的0.73分，手术前后差异有统计学意义（t=9.221,P=0.000）。术中均未出现穿孔、休克等严重并发症；1例术中少量出血，予电凝钳止血后出血停止；1例术后出现发热，加强抗生素应用后体温恢复正常，未再反复。随访3个月，5例患者症状明显好转，复查胃镜示创面愈合可，幽门阻力较前明显降低，GCSI评分均<2分，GES 4 h均<10%；1例糖尿病患者术后3个月再次出现恶心、呕吐和腹痛等症状，复查胃镜显示胃内大量潴留物，幽门阻力较大，GCSI评分3.25，GES 4 h为55%。结论 G-POEM治疗不同类型的难治性胃轻瘫短期疗效确切，可改善患者症状及胃排空功能，尤其针对外科术后及特发性胃轻瘫患者疗效更佳，可作为治疗胃轻瘫的重要选择。     

经口内镜下幽门肌切开术治疗近端胃切除术后胃轻瘫的疗效研究

目的 通过内镜下幽门肌切开术(G-POEM)治疗近端胃切除术后胃轻瘫,探讨其临床疗效及安全性.方法 选取2018年3月至2020年12月就诊于海军安庆医院的10例术后胃瘫综合征(PGS)患者作为研究对象,给予G-POEM治疗,所有患者治疗后3个月和6个月进行随访,观察临床症状改善情况、生活质量改善情况、营养状况改变情况...     

经口内镜下幽门肌切开术治疗胃大部切除术后胃瘫的疗效分析

目的 探讨经口内镜下幽门肌切开术（G-POEM）治疗胃大部切除术后胃瘫的有效性及安全性。方法 回顾性分析2016年8月至2018年6月在东南大学附属中大医院消化内科接受G-POEM治疗的47例胃大部切除术后胃瘫患者资料,分析治疗情况、手术相关并发症、胃瘫症状改善情况、胃排空功能改善情况。结果 47例患者均成功实施G-POEM,无一例出现与G-POEM相关的严重并发症。术后随访时间（9.8±5.8）个月（3~18个月）,患者术后第1、3、6、12、18个月胃瘫主要症状指数评分分别为1.6±0.5、1.2±0.4、1.1±0.6、1.4±0.3、1.7±0.3,均低于术前的3.8±1.1（P均＜0.01）,胃瘫症状显著改善。胃排空造影显示,术后第1、6、12、18个月造影剂半排空时间分别为（23.8±8.8）min、（21.2±9.5）min、（20.9±8.3）min、（26.4±7.8）min,较术前的（67.8±12.5）min均明显缩短（P均＜0.01）。三维超声胃窦容积测定提示,术后第1、6、12、18个月胃窦半排空时间分别为26.4（21.8,40.3）min、22.6（13.9,32.7）min、24.3（18.2,36.5）min、26.8（16.4,38.5）min,较术前的72.5（48.3,108.6）min均明显缩短（P均＜0.01）。结论 G-POEM治疗胃大部切除术后胃瘫具有良好的安全性,且远期疗效较满意。     

根除幽门螺杆菌对糖尿病胃轻瘫的疗效观察

目的 探讨根除幽门螺杆菌(Helicobacter pylori,Hp)治疗对糖尿病胃轻瘫(diabetic gastro-paresis,DGP)的疗效.方法 将Hp阳性DGP患者随机分为2组.对照组给予吗丁啉10 mg tid,治疗2周;治疗组给予丽珠得乐220 mg bid,阿莫西林1.0 bid,克拉霉素0.5 mg bid加吗丁啉10 mg tid,口服2周,观察记录治疗前后症状、体征变化,并做X线胃排空试验.结果 2型糖尿病伴胃轻瘫病人Hp感染率为76.2%(90/118),不伴胃轻瘫患者Hp感染43%(56/132),两者之间有显著差异(P＜0.01).Hp阳性DGP患者根除Hp后症状缓解,总有效率94.7%,单用吗丁啉治疗组,治疗后症状缓解有效率68%.两组比较有显著性差异(P＜0.01).结论 对DGP病人行Hp检测及根除治疗可显著缓解症状.     

胃轻瘫发病机制研究进展

胃轻瘫综合征(简称胃轻瘫)是一种以胃排空延缓为特征的临床症状群.主要表现为早饱、餐后上腹饱胀、恶心、发作性干呕和呕吐等,而有关检查无胃输出道器质性梗阻病变的证据.在临床上十分常见,但其发病机制仍不清楚,可能与血糖浓度、胃肠道神经损害、幽门螺杆菌(HP)感染及胃肠运动不协调等有关.1 血糖作用有统计资料表明:在Ⅰ型和Ⅱ型糖尿病患者,大约50%存在胃液体或/和固体食物排空延迟.Ad-     

2型糖尿病胃轻瘫患者幽门螺杆菌感染分析

2型糖尿病(T2DM)至少有50%以上的患者伴有糖尿病性胃轻瘫(DGP)〔1〕。一般认为,幽门螺杆菌(Hp)感染与消化性溃疡、活动性胃炎及胃癌密切相关〔2〕。近年来,有研究报道Hp感染与DGP有关,根除Hp有助于改善上腹不适、早饱、恶心、呕吐等症状〔3〕。本文对DGP患者进行Hp检测,进一步探讨Hp感染与DGP的临床相关性。     

根治幽门螺旋杆菌对糖尿病性胃轻瘫治疗的疗效观察

收集2015年6月~2018年6月期间180例糖尿病性胃轻瘫患者;分为对照组90例接受莫沙必利治疗,观察组接受克拉霉素、阿莫西林、奥美拉唑、铋剂治疗。结果对照组治疗有效率为83.33%低于观察组94.44%;对照组幽门螺旋杆菌阳性率为77.78%,治疗后为35.56%;转阴率为52.78%;观察组患者81.11%;治疗后转阴率为100.00%;P<0.05。结论根治幽门螺旋杆菌对糖尿病性胃轻瘫治疗的疗效显著,值得临床应用推广。     

DUAL-POEM for associated esophageal and gastric motility disorders: case series of endoscopic cardiomyotomy and endoscopic pyloromyotomy

Abstract

Background: Per-oral esophageal myotomy endoscopic (E-POEM) has clearly proved safety and efficiency in the treatment of esophageal spastic disorders. Recent studies on endoscopic pyloromyotomy (G-POEM) suggest good efficiency and safety in the treatment of gastroparesis. In recent literature, some reports showed both esophageal motility disorders and gastroparesis.

Methods: We report the case of four patients with esophageal and gastric motility disorders who were successfully treated with DUAL POEM (E-POEM and G-POEM) in two separate procedures.

Results: Clinical improvement was reported in all patients with a decrease of the Eckardt score for esophageal motility disorders and a decrease of the GCSI score for gastroparesis. No adverse events occurred after any procedure. These reported cases suggest that is possible to perform an E-POEM and a G-POEM in the same patient in two distinct procedures.

Conclusions: DUAL POEM seems to be faisable in patient with esophageal motility disorders associated with gastroparesis. The possibility of the concomitant occurrence of esophageal and gastric motility disorders could lead to change in practices with an overall assessment including gastric empting scintigraphy, high resolution manometry and pH-impedancemetry for patients with digestive motility disorders.     

Gastric peroral endoscopic myotomy for gastroparesis: A systematic review of efficacy and safety

IntroductionTo assess the efficacy and safety of gastric peroral endoscopic myotomy for the treatment of gastroparesis.MethodsPubMed, Embase, Cochrane Library and Web of Science databases were searched from their earliest records to May 2018. The evaluation of clinical efficacy and safety was based on gastric emptying scintigraphy normalization, the improvement in clinical symptoms and adverse event rate. R 3.5.0 software was used to calculate the pooled estimate rates by meta-analysis. The improvement rate of the Gastroparesis Cardinal Symptom Index score was analyzed at different follow-up times.ResultsFourteen studies with a total of 276 patients were included in this systematic review. The pooled gastric emptying scintigraphy normalization rate was 61.3% (95% CI, 51.5–70.8%) and clinical symptom improvement rate was 88.2% (95% CI, 83.6–93.1%). Intra-operative complications were found in about 3.2% (95% CI, 0.1–4.2%) of all included patients, and postoperative adverse events in 2.1% (95% CI, 0.3–4.8%). The mean Gastroparesis Cardinal Symptom Index score improvement rate was about 90.2% at one month follow-up, 83.3% at three months, 70.3% at six months, 52.4% at twelve months and 57.1% at eighteen months.DiscussionOur systematic review demonstrates that gastric peroral endoscopic myotomy is a safe and effective treatment for gastroparesis. Though the short-term outcomes are promising, prospective, randomized, controlled studies with large sample size and long-term follow-up are required to further confirm these results.     

Intracorporeal Shock Wave Lithotripsy (ISWL) in Bile Ducts under Peroral Endoscopy: Progress and Current Status

Attempting to use ISWL (intracorporeal shock wave lithotripsy) for treating large and difficult biliary stones was started in the mid 1970s, approximately 10 years before the introduction of ESWL (extracorporeal shock wave lithotripsy). However, in contrast to ESWL, ISWL did not quickly become popular in practise. The main reason for this delayed recognition, undoubtedly, lay in the technical difficulties of the peroral applications until the mid 1980s, when the development of an improved cholangios-cope system and a thin, flexible probe allowed the use of EHL (electrohydraulic lithotripsy) under direct vision during peroral cholangioscopy. Thanks to recent advances in technology, a powerful pulsed laser has begun to be used for ISWL through a 0.2 mm sized quartz fiber. A laser version of ISWL with such a thin probe is expected to facilitate its use by minimizing the endoscope system. The automatic stone-tissue recognition system which interrupts the laser discharge in case of wall contact is another useful advance in technology which increases the safety and therapeutic efficacy. Whereas laser techniques are still in development, ISWL with a laser will be the first choice technique for treating difficult bile duct stones after failure of mechanical lithotripsy and it also promises to improve its therapeutic efficacy for intrahepatic stones in combination with ESWL. In this article, the recent progresses and results of ISWL treatment were reviewed with a respect to the success of ESWL.     

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

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.     

Current Status of Endoscopic Papillectomy for Ampullary Tumors

Detection of tumors of the ampulla of Vater, including ampullary adenoma, has been improved by routine screening endoscopic procedures and imaging modalities. Endoscopic resection by endoscopic papillectomy is rapidly replacing classic surgical resection and is a less invasive procedure. Endoscopic resection can have a role not only in the final histopathologic diagnosis but also as a definite therapeutic option. However, the indications for endoscopic resection are not fully established, and endoscopic procedures are not standardized. Significant complications, including severe pancreatitis, intractable bleeding and duodenal perforation, are rare but can occur, especially in less experienced hands. Severe pancreatitis is the most feared complication, but it can be prevented by pancreatic duct stent insertion in most cases. However, in some cases, pancreatic stenting can be challenging after resection. Incomplete resections are sometimes performed to avoid complications. Endoscopic surveillance is also important for identifying and managing remnant adenomatous tissue or recurrent lesions. Further technical development is needed to expand the indications for this procedure, minimize complications and ensure a high success rate.