| Autor: |
Jesse M.P. Rappaport, Siva Raja, Scott Gabbard, Lucy Thuita, Madhusudhan R. Sanaka, Eugene H. Blackstone, Usman Ahmad, Atul C. Mehta, Olufemi Akindipe, Charles R. Lane, Shruti Gadre, Marie Budev, Carli Lehr, Wayne Tsuang, Jason Turowski, Nora Herceg, Maryam Valapour, Andrew Tang, Hafiz U. Siddiqui, Amberlee Shaut-Hale, Shinya Unai, James Yun, Haytham Elgharably, Alejandro C. Bribriesco, Sudish C. Murthy, Kenneth R. McCurry |
| Rok vydání: |
2021 |
| Předmět: |
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| Zdroj: |
The Journal of thoracic and cardiovascular surgery. 164(3) |
| ISSN: |
1097-685X |
| Popis: |
Gastroparesis is a debilitating and difficult to manage problem that has been reported in 20% to 90% of lung and heart-lung transplant recipients. The primary objective was to evaluate the safety and clinical effectiveness of per-oral endoscopic pyloromyotomy in relieving gastroparesis after lung transplant. Secondary objectives evaluated the effect of per-oral endoscopic pyloromyotomy on gastroesophageal reflux and allograft function.Fifty-two lung transplant recipients underwent per-oral endoscopic pyloromyotomy for refractory gastroparesis. Gastroparesis was assessed by a pre-per-oral endoscopic pyloromyotomy and post-per-oral endoscopic pyloromyotomy radionuclide gastric emptying test and Gastroparesis Cardinal Symptom Index. Secondary outcomes included 90-day complications, gastroesophageal reflux as measured by pH testing, and longitudinal spirometry measurements.Median time from lung transplant to per-oral endoscopic pyloromyotomy was 10.5 months. Twenty-eight patients had prior pyloric botulinum injection with either no improvement or relapse of symptoms. Post-per-oral endoscopic pyloromyotomy gastric emptying tests were available for 32 patients and showed a decrease in median gastric retention at 4 hours from 63.5% pre-per-oral endoscopic pyloromyotomy to 5.5% post-per-oral endoscopic pyloromyotomy (P .0001). Complete normalization of gastric emptying time was noted in 19 patients. Gastroparesis Cardinal Symptom Index score significantly improved after per-oral endoscopic pyloromyotomy (median, 23-3.5; P .0001). Post-per-oral endoscopic pyloromyotomy pH testing showed improved or stable DeMeester score in all patients except 1. Graft function (forced expiratory volume in 1 second) remained stable 1 year after per-oral endoscopic pyloromyotomy.The improvements in symptom score and radionuclide imaging observed in this uncontrolled study suggest that per-oral endoscopic pyloromyotomy is an effective strategy in the lung transplant population and can be performed with minimal morbidity. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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