SNFGE SNFGE
 
Thématique :
- Endoscopie/Imagerie
Originalité :
Intermédiaire
Solidité :
Très solide
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Docteur Vincent VALANTIN
Coup de coeur :
 
 
Endoscopy
  2018/11  
 
  2018 Nov;50(11):1053-1058.  
  doi: 10.1055/a-0596-7199.  
 
  Gastric peroral endoscopic myotomy for the treatment of refractory gastroparesis: a multicenter international experience.  
 
  Kahaleh M, Gonzalez JM, Xu MM, Andalib I, Gaidhane M, Tyberg A, Saumoy M, Baptista Marchena AJ, Barthet M  
  https://www.ncbi.nlm.nih.gov/pubmed/29649841  
 
 

Abstract

BACKGROUND:

 Gastroparesis is a difficult-to-treat motility disorder with a poor response to medical therapy. Gastric peroral endoscopic pyloromyotomy (G-POEM) has been offered as a novel therapy in the treatment of refractory gastroparesis. We present a multicenter case series of our experience with G-POEM.

METHODS:

 This is an international multicenter case series of patients who underwent G-POEM for the treatment of gastroparesis. The severity of gastroparesis was assessed by delayed gastric emptying scintigraphy (GES) and an elevated gastroparesis cardinal symptoms index (GCSI). Patients then underwent G-POEM using the submucosal tunneling technique. The primary endpoint was improvement in the GCSI score and improvement in gastric emptying on repeat scintigraphy. Secondary endpoints were technical success, complication rate, procedure duration, and length of hospital stay post-procedure.

RESULTS:

 G-POEM was technically successful in all 33 patients. Symptomatic improvement was seen in 28/33 patients (85 %), with a decrease in symptom score by GCSI from 3.3 to 0.8 at follow-up (P < 0.001). The mean procedure duration was 77.6 minutes (37 - 255 minutes). Mean GES improved significantly from 222.4 minutes to 143.16 minutes (P < 0.001). Complications were minimal and included bleeding (n = 1) and an ulcer (n = 1) treated conservatively. The mean length of hospital stay post-procedure was 5.4 days (1 - 14 days). The mean follow-up duration was 11.5 months (2 - 31 months).

CONCLUSION:

 G-POEM is a technically feasible, safe, and successful procedure for the treatment of refractory gastroparesis. A further multicenter comparative study should be performed to compare this technique to laparoscopic pyloromyotomy.

 

 
Question posée
 
Faisabilité, efficacité et innocuité du G POEM dans la gastroparésie comme alternative à la chirurgie ?
 
Question posée
 
85% de succès avec une amélioration très nette du score GCSI et de la vidange gastrique. Très peu de complication et un temps d’hospitalisation court.
 
Commentaires

Le POEM dans l’achalasie tend à s’imposer comme traitement de référence en lieu et place de la cardiomyotomie chirurgicale. Il devrait en être de même pour le G-POEM. Nous sommes en attente des études comparatives entre G_POEM et chirurgie mais aussi entre G-POEM et toxine botulique…

 
www.snfge.org