G-POEM – Gastrale perorale endoskopische Myotomie als Therapieoption bei chronischer Magenentleerungsstörung

Zusammenfassung

Vor der chirurgischen Intervention einer Pyloromyotomie mittels Laparoskopie scheuen sich viele Ärzte und Patienten. Die Wirksamkeit von Botulinumtoxin-Injektionen in den Pylorus ist nicht nachgewiesen [1] [2]. Pharmakologische Therapieansätze sind unbefriedigend und zeigen vielfältige Nebenwirkungen [3]. G-POEM ist eine Prozedur, die ihre Machbarkeit bei niedriger Komplikationsrate belegen konnte. In den bisherigen Publikationen konnte ein relativ hohes Ansprechen dokumentiert werden [4]. Noch kontrovers werden die Langzeiterfolge diskutiert [5]. Nach anfänglicher Euphorie tritt immer mehr das Problem der Patientenselektion in den Vordergrund. Die Symptome ebenso wie die Pathophysiologie der Magenentleerungsstörung sind vielfältig [6]. Die zur Verfügung stehenden diagnostischen Tests spiegeln die Variabilität der Erkrankung nicht wider [7] [8] [9] [10]. Eine Ausnahme scheint hier die postoperative Magenentleerungsstörung darzustellen [11]. G-POEM kann sowohl Therapeuten als auch Patienten vor einem weiteren invasiven Eingriff schützen.

Abstract

Many doctors and patients shy away from the surgical intervention of a pyloromyotomy using laparoscopy. The effectiveness of botulinum toxin injections into the pylorus has not been established [1] [2]. Pharmacological therapeutic approaches are unsatisfactory and show a wide range of side effects [3]. G-POEM is a procedure that has proven its feasibility with a low complication rate. A relatively high response could be documented in previous publications [4]. The long-term successes are still being discussed controversially [5]. After the initial euphoria, the problem of patient selection comes to the fore. The symptoms, as well as the pathophysiology of gastric emptying disorder, are diverse [6]. The diagnostic tests available do not reflect the variability of the disease [7] [8] [9] [10]. The postoperative gastric emptying disorder seems to be an exception. G-POEM can protect both therapists and patients from another invasive procedure.

Schlüsselwörter

G-POEM - Gastroparese - Postoperative Gastroparese

Keywords

G-POEM - gastroparesis - postoperative gastroparesis

Publication History

Received: 03 July 2021

Accepted after revision: 17 October 2021

Article published online:
24 November 2021

• Literatur

• 1 Vosoughi K, Ichkhanian Y, Benias P. et al. G-POEM for refractory gastroparesis: results from an international prospective trial. GUT 2021;
• 2 Arts J, Holvoert L, Caenepeel P. et al. Clinical trial: a randomized-controlled trail crossover study of intrapyloric injection of botox in gastroparesis. Aliment Pharmacol Ther 2007; 26: 1251-1258
• 3 Parkman HP, Hasler WL, Fisher RS. American Gastroenterological Association technical review on the diagnosis and treatment of gastroparesis. Gastroenterol 2004; 127: 1592-1622
• 4 Meybodi M, Qumseya J, Shakoor D. et al. Efficacy and feasibility of G-POEM in management of patients with refractory gastroparesis: a systematic review and metaanalysis. Endoscopy International Open 2019; 07: E322-E329
• 5 Ragi O, Jacques J, Branche J. et al. One-year results of G-POEM for refractory gastroparesis: a multicenter study. Endoscopy 2021; 53: 480-490
• 6 Grover M, Farrugia G, Stanghellini V. Gastroparesis: A turning point in understanding and treatment. GUT 2019; 68: 2238-2250
• 7 Weusten B, Barrett M, Bredenoord AJ. et al. Correction: Endoscopic management of gastrointestinal motility disorders: ESGE Guideline. Endoscopy 2020; 52: C6
• 8 Abell TL, Camilleri M, Donohoe K. et al. Consensus Recommendations for gastric emptying Scintigraphy: A joint report of the American Neurogastroenterology and Motility Society and the Society of the Nuclear Medicine. Am J Gastoenterol 2008; 103: 753-763
• 9 Janssen P, Harris MS, Jones M. et al. The relation between symptom improvement and gastric emptying in the treatment of diabetic and idiopathic gastroparesis. Am J Gastroenterol 2013; 108: 1382-1391
• 10 Sangnes D, Softeland E, Teigland T. et al. Comparing radiopaque markers and C13-labelled breath test in diabetic gastroparesis diagnostics. Clinical and Experimental Gastroenterology 2019; 12: 193-201
• 11 Strong A, Landreneau J, Cline M. et al. Per-Oral Pyloromyotomy (POP) for Medically Refractory Post-Surgical Gastroparesis. J Gastrointest Surg 2019; 23: 1095-1103
• 12 Jung HK, Choung RS, Locke GR. et al. The incidence, prevalence, and outcomes of patients with gastroparesis in Minnesota from 1996 to 2006. Gastroenterol 2009; 136: 1225-1233
• 13 Camilleri M. Clinical practice. Diabetic gastroparesis. N. Engl. J. Med 2007; 356: 820-829
• 14 Friedenberg FK, Palit A, Parkman HP. et al. Botulinum toxin A for the treatment of delayed gastric emptying. Am J Gastroenterol 2008; 103: 416-423
• 15 Arts J, Holvoet L, Caenepeel P. et al. Clinical trial: a randomized-controlled crossover study of intrapyloric injection of botulinum toxin in gastroparesis. Aliment Pharmacol Ther 2007; 26: 1251-1258
• 16 Khashab MA, Stein E, Clarke JO. et al. Gastric peroral endoscopic myotomy for refractory gatroparesis: First human endoscopic pyloromyotomy. Gastrointest Endosc 2013; 78: 764-768
• 17 Malik Z, Sankineni A, Parkman HP. Assessing pyloric sphincter pathophysiology using EndoFLIP in patients with gastroparesis. Neurogastroenterology and motility 2015; 27: 524-531
• 18 Malik Z, Kataria R, Modayil R. G-POEM for the treatment of refractory gastroparesis: Early experience. Dig Dis Sci 2018; 63: 2405-2412
• 19 Revicki DA, Rentz AM, Dubois D. et al. Gastroparesis Cardinal Symptom Index (GCSI): development and validation of a patient reported assessment of severity of gastroparesis symptoms. Qual Life Res 2004; 13: 833-844
• 20 Garg R, Mohan B, Aggarwal M. et al. Peroral Pyloromytomy is Effective and Safe for Postsurgical Gastroparesis. J Gastrointestinal Surg 2020; 24: 1417-1420
• 21 Tan J, Shrestha SM, Wei M. et al. Feasibility, safety, and long-term efficacy of gastric peroral endoscopic myotomie for postsurgical gastroparesis: a single-center and retrospective Study of a prospective Database. Surg Endosc 2020;
• 22 Friedenberg FK, Palit A, Parmann HP. et al. Botox A for the treatment of delayed gastric emptying. Am J Gastroenterol 2008; 103: 416
• 23 Lee A, Rao S, Nguyen L. et al. Validation of Diagnostic and Performance Characteristics of the Wireless Motility Capsule in Patients With Suspected Gastroparesis. Clin Gastroenterol Hepatol 2019; 17: 1770-1779
• 24 Murray FR, Schindler V, Henete JM. et al. Pyloric dilatation with the EndoFLIP in gastroparesis improves emptying, pyloric distensibility and symptoms. Gastrointest Endosc 2021;
• 25 Vosoughi K, Ichkhanian Y, Jacques J. et al. Role of endoFLIP in predicting the outcome of G-POEM. Gastrointestinal Endosc 2020; 91: 1289-1299
• 26 Pasricha P, Grover M, Yates K. et al. Functional dyspepsia and gastroparesis in tertiary care are interchangeable syndromes with common clinical and pathologic features. Gastroenterology 2021; 160: 2006-2017