SNFGE SNFGE
 
Thématique :
- Colo-proctologie
Originalité :
Intermédiaire
Solidité :
Très solide
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Philippe DUCROTTE
Coup de coeur :
 
 
Alimentary Pharmacology & Therapeutics (APT)
  2017/08  
 
  2017 Aug;46(3):364-370.  
  doi: 10.1111/apt.14132.  
 
  G-POEM with antro-pyloromyotomy for the treatment of refractory gastroparesis: mid-term follow-up and factors predicting outcome.  
 
  Gonzalez JM, Benezech A, Vitton V, Barthet M  
  https://www.ncbi.nlm.nih.gov/pubmed/28504312  
 
 

Abstract

BACKGROUND:

Gastric peroral endoscopic pyloromyotomy (G-POEM) was introduced for treating refractory gastroparesis.

AIM:

To present a series of patients focussed on clinical mid-term efficacy and predictive outcomes factors.

METHODS:

This was a single centre study of 29 patients operated on between January 2014 and April 2016, with disturbed gastric emptying scintigraphy (GES) and/or elevated Gastroparesis Cardinal Symptoms Index (GCSI). The procedures were performed as previously described. The primary endpoint was the efficacy at 3 and 6 months, based on GCSI and symptoms. The secondary endpoints were GES evolution, procedure reproducibility and safety, and identification of predictive factors for success.

RESULTS:

There were 10 men, 19 women (mean age 52.8±18). The technical success rate was 100% (average 47 minutes). There were two complications managed conservatively: one bleeding and one abscess. The median follow-up was 10±6.4 months. The clinical success rate was 79% at 3 months, 69% at 6 months, with a significant decrease in the mean GCSI compared to pre-operatively (3.3±0.9 vs 1±1.2 and 1.1±0.9 respectively). The GES (n=23) normalised in 70% of cases, with a significant improvement of the mean half emptying time and retention at 2 hours, and a discordance in 21% of the cases. In univariate analysis, diabetes and female gender were significantly associated with risk of failure, but not confirmed in multivariate analysis.

CONCLUSIONS:

The mid-term efficacy of G-POEM reaches 70% at 6 months. The procedure remains reproducible and safe. Diabetes and female gender were predictive of failure.

 

 
Question posée
 
La pyloromyotomie endoscopique peut-elle être une solution thérapeutique pour améliorer des symptômes réfractaires associés à une gastroparésie ?
 
Question posée
 
Dans les mains d’une équipe experte, la réponse est oui chez 7 malades sur 10 avec une amélioration des symptômes et de la vidange gastrique.
 
Commentaires

Ce travail confirme que les traitements endoscopiques ont leur place dans la prise en charge de la gastroparésie réfractaire avec une réserve pour les malades diabétiques. L’exploration du fonctionnement pylorique par Endoflip ® pour individualiser chez les patients gastroparétiques ceux ayant un dysfonctionnement pylorique, sera peut être un moyen de mieux cerner encore les indications.

 
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