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Peroral endoscopic pyloromyotomy is efficacious and safe for refractory gastroparesis: prospective trial with assessment of pyloric function

Jeremie Jacques 1 Lauriane Pagnon 2 Florent Hure 3 Romain Legros 1 Sabrina Crepin 4 Anne-Laure Fauchais 5 Sylvain Palat 5 Philippe Ducrotté 6, 7, 8, 9 Benoît Marin 10, 3 Sébastien Fontaine 11 Nour Boubaddi 12 Marie-Pierre Clement 13 Denis Sautereau 1 Véronique Loustaud-Ratti 1 Guillaume Gourcerol 7, 8, 9, 14 Jacques Monteil 15
1 Service d'Hépato-Gastro-Entérologie et Nutrition [CHU Limoges]
2 XLIM - XLIM
3 CHU Limoges
4 Service de Pharmacologie, toxicologie et pharmacovigilance [CHU Limoges]
5 Service de Médecine interne A et polyclinique médicale [CHU Limoges]
6 Service d'Hépato-Gastroentérologie [CHU Rouen]
7 ADEN - Nutrition, inflammation et dysfonctionnement de l'axe intestin-cerveau
8 IRIB - Institute for Research and Innovation in Biomedicine
9 UNIROUEN UFR Santé - UNIROUEN - UFR Santé
10 NET - Neuroépidémiologie Tropicale
11 Service de diabétologie, CHU de Toulouse, Toulouse, France
12 Service de Gastroentérologie, CH Brive-la-Gaillarde, Brive-la-Gaillarde, France.
13 Service de Diabétologie, CHU Limoges,
14 Service de physiologie digestive, urinaire, respiratoire et de l'exercice [CHU Rouen]
15 Service de médecine nucléaire [CHU Limoges]
Abstract : Background Gastroparesis is a functional disorder with a variety of symptoms that is characterized by delayed gastric emptying in the absence of mechanical obstruction. A recent series of retrospective studies has demonstrated that peroral endoscopic pyloromyotomy (G-POEM) is a promising endoscopic procedure for treating patients with refractory gastroparesis. The aim of this prospective study was to evaluate the feasibility, safety, and efficacy of G-POEM. Methods 20 patients with refractory gastroparesis (10 diabetic and 10 nondiabetic) were prospectively included in the trial. Patients were treated by G-POEM after evaluation of pyloric function using an endoscopic functional luminal imaging probe. Clinical responses were evaluated using the Gastroparesis Cardinal Symptom Index (GCSI), and quality of life was assessed using the Patient Assessment of Upper Gastrointestinal Disorders – Quality of Life scale and the Gastrointestinal Quality of Life Index scores. Gastric emptying was measured using 4-hour scintigraphy before G-POEM and at 3 months. Results Feasibility of the procedure was 100 %. Compared with baseline values, G-POEM significantly improved symptoms (GCSI: 1.3 vs. 3.5; P < 0.001), quality of life, and gastric emptying (T½: 100 vs. 345 minutes, P < 0.001; %H2: 56.0 % vs. 81.5 %, P < 0.001; %H4: 15.0 % vs. 57.5 %, P = 0.003) at 3 months. The clinical success of G-POEM using the functional imaging probe inflated to 50 mL had specificity of 100 % and sensitivity of 72.2 % (P = 0.04; 95 % confidence interval 0.51 – 0.94; area under the curve 0.72) at a distensibility threshold of 9.2 mm2/mmHg. Conclusion G-POEM was efficacious and safe for treating refractory gastroparesis, especially in patients with low pyloric distensibility.
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https://hal-normandie-univ.archives-ouvertes.fr/hal-02368528
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Submitted on : Monday, November 18, 2019 - 3:39:35 PM
Last modification on : Sunday, October 25, 2020 - 7:06:17 AM

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COMUE-NORMANDIE | ADEN | UNIROUEN | UNILIM | GEIST | CNRS | NET | POLITIQUES-PUBLIQUES

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Jeremie Jacques, Lauriane Pagnon, Florent Hure, Romain Legros, Sabrina Crepin, et al.. Peroral endoscopic pyloromyotomy is efficacious and safe for refractory gastroparesis: prospective trial with assessment of pyloric function. Endoscopy, Thieme Publishing, 2018, 51 (01), pp.40-49. ⟨10.1055/a-0628-6639⟩. ⟨hal-02368528⟩

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