Comprehensive Analysis of Adverse Events Associated with Gastric Peroral Endoscopic Myotomy: An International Multicenter Study.
Adverse events
G-POEM
Gastric peroral endoscopic myotomy
Gastroparesis
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
04 2021
04 2021
Historique:
received:
30
12
2019
accepted:
15
04
2020
pubmed:
25
4
2020
medline:
3
7
2021
entrez:
25
4
2020
Statut:
ppublish
Résumé
Gastric peroral endoscopic myotomy (G-POEM) has emerged as an effective management approach for patients with refractory gastroparesis. This study aims to comprehensively study the safety of G-POEM and describe the predictive factors of adverse events (AEs) occurrence. This study is a retrospective study involving 13 tertiary care centers (7 USA, 1 South America, 4 Europe, and 1 Asia). Patients who underwent G-POEM for refractory gastroparesis were included. Cases were identified by the occurrence of AEs. For each case, two controls were randomly selected and matched for age (± 10 years), gender, and etiology of gastroparesis. A total of 216 patients underwent G-POEM for gastroparesis. Overall, 31 (14%) AEs were encountered [mild 24 (77%), moderate 5 (16%), and severe 2 (6%)] during the duration of the study. The most common AE was abdominal pain (n = 16), followed by mucosotomy (n = 5) and capnoperitoneum (n = 4), and AEs were most commonly identified within the first 48-h post-procedure 18 (58%). The risk of adverse event occurrence was significantly higher for endoscopists with experience of < 20 G-POEM procedures (OR 3.03 [1.03-8.94], p < 0.05). G-POEM seems to be a safe intervention for refractory gastroparesis. AEs are most commonly mild and managed conservatively. Longitudinal mucosal incision, use of hook knife, use of clips for mucosal closure and endoscopist's experience with > 20 G-POEM procedures is significantly associated with decreased incidence of AEs.
Sections du résumé
BACKGROUND
Gastric peroral endoscopic myotomy (G-POEM) has emerged as an effective management approach for patients with refractory gastroparesis. This study aims to comprehensively study the safety of G-POEM and describe the predictive factors of adverse events (AEs) occurrence.
METHODS
This study is a retrospective study involving 13 tertiary care centers (7 USA, 1 South America, 4 Europe, and 1 Asia). Patients who underwent G-POEM for refractory gastroparesis were included. Cases were identified by the occurrence of AEs. For each case, two controls were randomly selected and matched for age (± 10 years), gender, and etiology of gastroparesis.
RESULTS
A total of 216 patients underwent G-POEM for gastroparesis. Overall, 31 (14%) AEs were encountered [mild 24 (77%), moderate 5 (16%), and severe 2 (6%)] during the duration of the study. The most common AE was abdominal pain (n = 16), followed by mucosotomy (n = 5) and capnoperitoneum (n = 4), and AEs were most commonly identified within the first 48-h post-procedure 18 (58%). The risk of adverse event occurrence was significantly higher for endoscopists with experience of < 20 G-POEM procedures (OR 3.03 [1.03-8.94], p < 0.05).
CONCLUSION
G-POEM seems to be a safe intervention for refractory gastroparesis. AEs are most commonly mild and managed conservatively. Longitudinal mucosal incision, use of hook knife, use of clips for mucosal closure and endoscopist's experience with > 20 G-POEM procedures is significantly associated with decreased incidence of AEs.
Identifiants
pubmed: 32328824
doi: 10.1007/s00464-020-07570-z
pii: 10.1007/s00464-020-07570-z
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1755-1764Commentaires et corrections
Type : ErratumIn
Références
Parkman HP, Hasler WL, Fisher RS (2004) American Gastroenterological Association technical review on the diagnosis and treatment of gastroparesis. Gastroenterology 127:1592–1622
doi: 10.1053/j.gastro.2004.09.055
Cherian D, Parkman HP (2012) Nausea and vomiting in diabetic and idiopathic gastroparesis. Neurogastroenterol Motil 24(217–222):e103
Dudekula A, O'Connell M, Bielefeldt K (2011) Hospitalizations and testing in gastroparesis. J Gastroenterol Hepatol 26:1275–1282
doi: 10.1111/j.1440-1746.2011.06735.x
Tang DM, Friedenberg FK (2011) Gastroparesis: approach, diagnostic evaluation, and management. Dis Mon 57:74–101
doi: 10.1016/j.disamonth.2010.12.007
Hasler WL (2011) Gastroparesis: pathogenesis, diagnosis and management. Nat Rev Gastroenterol Hepatol 8:438–453
doi: 10.1038/nrgastro.2011.116
Sangnes DA, Softeland E, Biermann M, Gilja OH, Thordarson H, Dimcevski G (2016) Gastroparesis—causes, diagnosis and treatment. Tidsskr Nor Laegeforen 136:822–826
doi: 10.4045/tidsskr.15.0503
Jones MP, Maganti K (2003) A systematic review of surgical therapy for gastroparesis. Am J Gastroenterol 98:2122–2129
doi: 10.1111/j.1572-0241.2003.07721.x
Abrahamsson H (2007) Treatment options for patients with severe gastroparesis. Gut 56:877–883
doi: 10.1136/gut.2005.078121
Khashab MA, Stein E, Clarke JO, Saxena P, Kumbhari V, Chander Roland B, Kalloo AN, Stavropoulos S, Pasricha P, Inoue H (2013) Gastric peroral endoscopic myotomy for refractory gastroparesis: first human endoscopic pyloromyotomy (with video). Gastrointest Endosc 78:764–768
doi: 10.1016/j.gie.2013.07.019
Aghaie Meybodi M, Qumseya BJ, Shakoor D, Lobner K, Vosoughi K, Ichkhanian Y, Khashab MA (2019) Efficacy and feasibility of G-POEM in management of patients with refractory gastroparesis: a systematic review and meta-analysis. Endosc Int Open 7:E322–e329
doi: 10.1055/a-0812-1458
Camilleri M, Parkman HP, Shafi MA, Abell TL, Gerson L (2013) Clinical guideline: management of gastroparesis. Am J Gastroenterol 108:18–37
doi: 10.1038/ajg.2012.373
Vosoughi K et al (2019) 644 Gastric peroral endoscopic myotomy (G-POEM) for the treatment of refractory gastroparesis: results from the first international prospective trial. Gastrointest Endosc. https://doi.org/10.1016/j.gie.2019.04.098
doi: 10.1016/j.gie.2019.04.098
Louazon T, Rivory J, Roman S, Mion F, Ponchon T, Pioche M (2016) Temporary dumping syndrome after gastric peroral endoscopic myotomy: should we control the glycemia? Endoscopy 48(Suppl 1 UCTN):E10–11
pubmed: 26800191
Cotton PB, Eisen GM, Aabakken L, Baron TH, Hutter MM, Jacobson BC, Mergener K, Nemcek A Jr, Petersen BT, Petrini JL, Pike IM, Rabeneck L, Romagnuolo J, Vargo JJ (2010) A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 71:446–454
doi: 10.1016/j.gie.2009.10.027
Benias PC, Khashab MA (2017) Gastric peroral endoscopic pyloromyotomy therapy for refractory gastroparesis. Curr Treat Options Gastroenterol 15:637–647
doi: 10.1007/s11938-017-0156-9
Gonzalez JM, Benezech A, Vitton V, Barthet M (2017) G-POEM with antro-pyloromyotomy for the treatment of refractory gastroparesis: mid-term follow-up and factors predicting outcome. Aliment Pharmacol Ther 46:364–370
doi: 10.1111/apt.14132
Mekaroonkamol P, Dacha S, Wang L, Li X, Jiang Y, Li L, Li T, Shahnavaz N, Sakaria S, LeVert FE, Keilin S, Willingham F, Christie J, Cai Q (2019) Gastric peroral endoscopic pyloromyotomy reduces symptoms, increases quality of life, and reduces health care use for patients with gastroparesis. Clin Gastroenterol Hepatol 17:82–89
doi: 10.1016/j.cgh.2018.04.016
Tao J, Patel V, Mekaroonkamol P, Luo H, Li B, Guan Q, Shen S, Chen H, Cai Q (2019) Technical aspects of peroral endoscopic pyloromyotomy. Gastrointest Endosc Clin N Am 29:117–126
doi: 10.1016/j.giec.2018.08.012
Geyl S, Legros R, Charissou A, Mesturoux L, Couquet CY, Carrier P, Brayette A, El-Ouafi Z, Loustaud-Ratti V, Sautereau D, Monteil J, Jacques J (2016) Peroral endoscopic pyloromyotomy accelerates gastric emptying in healthy pigs: proof of concept. Endosc Int Open 4:E796–799
doi: 10.1055/s-0042-108192
Chaves DM, Gusmon CC, Mestieri LH, de Moura EG, Veras MM, Pessorrusso FC, Sakai P (2014) A new technique for performing endoscopic pyloromyotomy by gastric submucosal tunnel dissection. Surg Laparosc Endosc Percutan Tech 24:e92–94
doi: 10.1097/SLE.0b013e31829cec0e
Jung Y, Lee J, Gromski MA, Kato M, Rodriguez S, Chuttani R, Matthes K (2015) Assessment of the length of myotomy in peroral endoscopic pyloromyotomy (G-POEM) using a submucosal tunnel technique (video). Surg Endosc 29:2377–2384
doi: 10.1007/s00464-014-3948-1
Jacques J, Pagnon L, Hure F, Legros R, Crepin S, Fauchais AL, Palat S, Ducrotte P, Marin B, Fontaine S, Boubaddi NE, Clement MP, Sautereau D, Loustaud-Ratti V, Gourcerol G, Monteil J (2019) Peroral endoscopic pyloromyotomy is efficacious and safe for refractory gastroparesis: prospective trial with assessment of pyloric function. Endoscopy 51:40–49
doi: 10.1055/a-0628-6639
Kahaleh M, Gonzalez JM, Xu MM, Andalib I, Gaidhane M, Tyberg A, Saumoy M, Baptista Marchena AJ, Barthet M (2018) Gastric peroral endoscopic myotomy for the treatment of refractory gastroparesis: a multicenter international experience. Endoscopy 50:1053–1058
doi: 10.1055/a-0596-7199
Li L, Spandorfer R, Qu C, Yang Y, Liang S, Chen H, Xue H, Cai Q (2018) Gastric per-oral endoscopic myotomy for refractory gastroparesis: a detailed description of the procedure, our experience, and review of the literature. Surg Endosc 32:3421–3431
doi: 10.1007/s00464-018-6112-5
Malik Z, Kataria R, Modayil R, Ehrlich AC, Schey R, Parkman HP, Stavropoulos SN (2018) Gastric per oral endoscopic myotomy (G-POEM) for the treatment of refractory gastroparesis: early experience. Dig Dis Sci 63:2405–2412
doi: 10.1007/s10620-018-4976-9
Shlomovitz E, Pescarus R, Cassera MA, Sharata AM, Reavis KM, Dunst CM, Swanstrom LL (2015) Early human experience with per-oral endoscopic pyloromyotomy (POP). Surg Endosc 29:543–551
doi: 10.1007/s00464-014-3720-6