Double pyloromyotomy versus single pyloromyotomy at peroral endoscopic pyloromyotomy in treatment of gastroparesis (with video).

Short-term outcomes of double pyloromyotomy versus single pyloromyotomy at peroral endoscopic pyloromyotomy in treatment of gastroparesis (with video).:

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Short-term outcomes of double pyloromyotomy versus single pyloromyotomy at peroral endoscopic pyloromyotomy in treatment of gastroparesis (with video).

Gastrointest Endosc. 2020 Jan 17;:

Authors: Abdelfatah MM, Li B, Kapil N, Noll A, Li L, Luo H, Chen H, Xia L, Chen X, Patel V, Mekaroonkamol P, Massaad J, Keilin S, Cai Q

Abstract

BACKGROUND AND AIMS: Gastroparesis (Gp) is a chronic debilitating disorder rising in prevalence and hospitalizations. Gastric peroral endoscopic pyloromyotomy (POP or GPOEM) is a novel technique in the treatment of refractory Gp. Despite the initial promising results of GPOEM, one-third of patients do not exhibit any clinical response. Furthermore, loss of clinical response was reported in several studies. No response or loss of response after GPOEM may be related to inadequate myotomy. The aim of our study is to examine whether double pyloromyotomy at GPOEM is superior to single pyloromyotomy.

METHOD: A retrospective case-controlled study of patients who underwent GPOEM for refractory Gp at our tertiary care institution between June 2015 and March 2018 was performed. Because the follow-up time for the single myotomy group was much longer than that of the double-myotomy group, we matched the length of follow-up for the single myotomy group to that of the double myotomy group. The outcomes were measured by the changes in Gp cardinal symptom index (GCSI) before and 3 to 6 months after the procedure. Adverse events and other procedural and clinical parameters were also compared.

RESULTS: Ninety patients underwent GPOEM (55 single and 35 double pyloromyotomy) Mean age was 47 ±14 years old, mean duration of symptoms was 5.3 ± 4.4 years. Average GCSI was 3.8 before the GPOEM and the average GCSI 6 months after procedure was 1.8 37 out of 55 (67%) patients underwent single pyloromyotomy achieved clinical response compared with 30 out of 35 (86%) patients receiving double pyloromyotomy. There were no significant differences among procedure time, postoperative pain or length of hospital stay between the 2 groups. There was no difference in adverse events in the 2 pyloromyotomy groups.

CONCLUSION: Double pyloromyotomy is a safe and feasible technique during GPOEM. Clinical success was higher in patients undergoing double pyloromyotomy compared with single pyloromyotomy in this nonrandomized, short-term follow-up study. Long-term studies are needed to further confirm our results.

PMID: 31958460 [PubMed - as supplied by publisher]