Do antro-duodenal manometry parameters predict clinical response after gastric peroral endoscopic pyloromyotomy in refractory gastroparesis?

Autor: Sweerts KWE; Department of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, the Netherlands., Mujagic Z; Department of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, the Netherlands., Straathof JWA; Department of Gastroenterology and Hepatology, Maxima Medical Center, Veldhoven, the Netherlands., Hereijgers MJM; Department of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, the Netherlands., Keszthelyi D; Department of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, the Netherlands., Conchillo JM; Department of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, the Netherlands.
Jazyk: angličtina
Zdroj: Neurogastroenterology and motility [Neurogastroenterol Motil] 2024 Oct; Vol. 36 (10), pp. e14879. Date of Electronic Publication: 2024 Jul 26.
DOI: 10.1111/nmo.14879
Abstrakt: Background: Gastric peroral endoscopic pyloromyotomy (G-POEM) is a promising therapeutic modality for refractory gastroparesis (GP). However, as characteristics of suitable patients for G-POEM remain unclear, antro-duodenal manometry (ADM) has been suggested to provide objective parameters for patient selection. The aim of the present study was to identify ADM parameters as predictors for treatment response after G-POEM in refractory GP.
Methods: Refractory GP patients who underwent a G-POEM between 2017 and 2022 were included. The following ADM parameters were mainly scored: antral hypomotility, pylorospasm, and the presence of neuropathic enteric patterns. Treatment response was defined as a GCSI-score decrease of ≥1 point 12 months after G-POEM. Explorative analyses were performed on potential predictors of response using logistic regression analysis.
Key Results: Sixty patients (52 women, mean age 52 ± 14 years.) with refractory GP (33 idiopathic, 16 diabetic, 11 postsurgical) were included. Clinical response data were available for 52 patients. In 8 out of 60 patients, it was not feasible to advance the catheter beyond the pylorus. Abnormal ADM was found in 46/60 patients (77%). Antral hypomotility and pylorospasm were found in respectively 33% and 12% of patients. At least one neuropathic enteric dysmotility pattern was found in 58% of patients. No differences were found when comparing baseline ADM parameters between clinical response groups at 12 months follow-up. Following explorative analyses, no ADM parameters were identified to predict clinical response 12 months after G-POEM.
Conclusions and Inferences: No ADM parameters were identified as predictors of clinical response after G-POEM in refractory GP patients. Additionally, a high percentage of abnormal ADM tracings was found, in particular with relation to enteric dysmotility, while only a low percentage of patients showed antral hypomotility or pylorospasm.
(© 2024 The Author(s). Neurogastroenterology & Motility published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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