PDF herunterladen
Endoscopy 2023; 55(06): 508-514
DOI: 10.1055/a-1986-4292
Original article

Response to botulinum toxin may predict response to peroral pyloromyotomy in patients with gastroparesis

Vaibhav Wadhwa
1   Center for Interventional Gastroenterology, University of Texas Health Science, Houston, Texas, United States
,
Adalberto Gonzalez 
2   Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, Florida, United States
,
Francisco Azar
2   Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, Florida, United States
,
Harjinder Singh
2   Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, Florida, United States
,
Kapil Gupta
3   Department of Gastroenterology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
,
Hong Liang
4   Department of Clinical Research, Cleveland Clinic Florida, Weston, Florida, United States
,
Alison Schneider
2   Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, Florida, United States
,
Jeffery Ponsky
5   Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, United States
,
Tolga Erim
2   Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, Florida, United States
,
John Rodriguez
5   Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, United States
,
Fernando J. Castro
2   Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, Florida, United States
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
    Lizenzen und Reprints


Abstract

Background Patients with gastroparesis who have undergone prior intrapyloric botulinum toxin injection (BTI) may seek an opinion regarding peroral pyloromyotomy (POP). There are only two small reports assessing the role of BTI as a predictor for successful treatment with POP.

Methods We performed a retrospective cohort study to assess whether symptomatic improvement after BTI predicts a response to POP. We included 119 patients who had undergone both BTI and POP at Cleveland Clinic Ohio or Cleveland Clinic Florida from January 2016 to September 2019.

Results 65.5 % of patients had symptomatic improvement after BTI. Gastroparesis Cardinal Symptom Index (GCSI) scores were available for 74 patients, with 64 % achieving a response to POP, defined as a decrease in mean GCSI ≥ 1. In multivariable analysis, response to BTI (odds ratio [OR] 7.7 [95 %CI 2.2–26.1]) and higher pre-POP GCSI score (OR 2.3 [95 %CI 1.2–4.6]) were independent predictors of response to POP.

Conclusions Clinical improvement after BTI is a predictor of response to POP in patients with gastroparesis. This information may aid in improving patient selection for POP.

Tables 1 s–7 s



Publikationsverlauf

Eingereicht: 20. Februar 2022

Angenommen nach Revision: 23. November 2022

Accepted Manuscript online:
23. November 2022

Artikel online veröffentlicht:
10. Februar 2023

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Grover M, Farrugia G, Stanghellini V. Gastroparesis: a turning point in understanding and treatment. Gut 2019; 68: 2238-2250
    CrossrefPubMedSuche in Google Scholar
  • 2 Liu N, Abell T. Gastroparesis updates on pathogenesis and management. Gut Liver 2017; 11: 579-589
    CrossrefPubMedSuche in Google Scholar
  • 3 Khashab MA, Stein E, Clarke JO. et al. Gastric peroral endoscopic myotomy for refractory gastroparesis: first human endoscopic pyloromyotomy (with video). Gastrointest Endosc 2013; 78: 764-768
    CrossrefPubMedSuche in Google Scholar
  • 4 Dacha S, Mekaroonkamol P, Li L. et al. Outcomes and quality-of-life assessment after gastric per-oral endoscopic pyloromyotomy (with video). Gastrointest Endosc 2017; 86: 282-289
    CrossrefPubMedSuche in Google Scholar
  • 5 Ezzeddine D, Jit R, Katz N. et al. Pyloric injection of botulinum toxin for treatment of diabetic gastroparesis. Gastrointest Endosc 2002; 55: 920-923
    CrossrefPubMedSuche in Google Scholar
  • 6 Miller LS, Szych GA, Kantor SB. et al. Treatment of idiopathic gastroparesis with injection of botulinum toxin into the pyloric sphincter muscle. Am J Gastroenterol 2002; 97: 1653-1660
    CrossrefPubMedSuche in Google Scholar
  • 7 Arts J, van Gool S, Caenepeel P. et al. Influence of intrapyloric botulinum toxin injection on gastric emptying and meal-related symptoms in gastroparesis patients. Aliment Pharmacol Ther 2006; 24: 661-667
    CrossrefPubMedSuche in Google Scholar
  • 8 Bromer MQ, Friedenberg F, Miller LS. et al. Endoscopic pyloric injection of botulinum toxin A for the treatment of refractory gastroparesis. Gastrointest Endosc 2005; 61: 833-839
    CrossrefPubMedSuche in Google Scholar
  • 9 Rameshshanker R, Smith LA, Southern P. et al. Gastroparesis and botulinum toxin. Gut 2011; 60: A105-A106
    CrossrefPubMedSuche in Google Scholar
  • 10 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
    CrossrefPubMedSuche in Google Scholar
  • 11 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
    CrossrefPubMedSuche in Google Scholar
  • 12 Ukleja A, Tandon K, Shah K. et al. Endoscopic botox injections in therapy of refractory gastroparesis. World J Gastrointest Endosc 2015; 7: 790-798
    CrossrefPubMedSuche in Google Scholar
  • 13 Khoury T, Mizrahi M, Mahamid M. et al. State of the art review with literature summary on gastric peroral endoscopic pyloromyotomy for gastroparesis. J Gastroenterol Hepatol 2018; 33: 1829-1833
    CrossrefPubMedSuche in Google Scholar
  • 14 Spadaccini M, Maselli R, Chandrasekar VT. et al. Gastric peroral endoscopic pyloromyotomy for refractory gastroparesis: a systematic review of early outcomes with pooled analysis. Gastrointest Endosc 2020; 91: 746-752
    CrossrefPubMedSuche in Google Scholar
  • 15 Uemura KL, Chaves D, Bernardo WM. et al. Peroral endoscopic pyloromyotomy for gastroparesis: a systematic review and meta-analysis. Endosc Int Open 2020; 08: E911-E923
    Thieme ConnectPubMedSuche in Google Scholar
  • 16 Meybodi MA, Qumseya BJ, Shakoor D. et al. Efficacy and feasibility of G-POEM in management of patients with refractory gastroparesis: a systematic review and meta-analysis. Endosc Int Open 2019; 07: E322-E329
    Thieme ConnectPubMedSuche in Google Scholar
  • 17 Pasricha PJ, Camilleri M, Hasler WL. et al. White Paper AGA: Gastroparesis: clinical and regulatory insights for clinical trials. Clin Gastroenterol Hepatol 2017; 15: 1184-1190
    CrossrefPubMedSuche in Google Scholar
  • 18 Abdelfatah MM, Noll A, Kapil N. et al. Long-term outcome of gastric per-oral endoscopic pyloromyotomy in treatment of gastroparesis. Clin Gastroenterol Hepatol 2021; 19: 816-824
    CrossrefPubMedSuche in Google Scholar
  • 19 Annese V, Bassotti G, Coccia G. et al. A multicentre randomised study of intrasphincteric botulinum toxin in patients with oesophageal achalasia. GISMAD Achalasia Study Group. Gut 2000; 46: 597-600
    CrossrefPubMedSuche in Google Scholar
  • 20 D’Onofrio V, Annese V, Miletto P. et al. Long-term follow-up of achalasic patients treated with botulinum toxin. Dis Esophagus 2000; 13: 96-101
    CrossrefPubMedSuche in Google Scholar
  • 21 Malik Z, Kataria R, Modayil R. et al. Gastric per oral endoscopic myotomy (G-POEM) for the treatment of refractory gastroparesis: early experience. Dig Dis Sci 2018; 63: 2405-2412
    CrossrefPubMedSuche in Google Scholar
  • 22 Gregor L, Wo J, DeWitt J. et al. Gastric peroral endoscopic myotomy for the treatment of refractory gastroparesis: a prospective single-center experience with mid-term follow-up (with video). Gastrointest Endosc 2021; 94: 35-44
    CrossrefPubMedSuche in Google Scholar
  • 23 Lee AA, Hasler WL. G-POEM for gastroparesis: is there pressure to go with the flow?. Dig Dis Sci 2018; 63: 2165-2167
    CrossrefPubMedSuche in Google Scholar
  • 24 Vosoughi K, Ichkhanian Y, Benias P. et al. Gastric per-oral endoscopic myotomy (G-POEM) for refractory gastroparesis: results from an international prospective trial. Gut 2022; 71: 25-33
    CrossrefPubMedSuche in Google Scholar
  • 25 Bapaye A, Dubale NA. Gastric per-oral endoscopic myotomy: indications, technique, outcomes, and future directions. Int J Gastrointest Interv 2020; 9: 72-77
    CrossrefPubMedSuche in Google Scholar
  • 26 Xu J, Chen T, Elkholy S. et al. Gastric peroral endoscopic myotomy (G-POEM) as a treatment for refractory gastroparesis: long-term outcomes. Can J Gastroenterol Hepatol 2018; 2018: 6409698
    PubMedSuche in Google Scholar
  • 27 Rodriguez JH, Haskins IN, Strong AT. et al. Per oral endoscopic pyloromyotomy for refractory gastroparesis: initial results from a single institution. Surg Endosc 2017; 31: 5381-5388
    CrossrefPubMedSuche in Google Scholar
  • 28 Mohan BP, Chandan S, Jha LK. et al. Clinical efficacy of gastric per-oral endoscopic myotomy (G-POEM) in the treatment of refractory gastroparesis and predictors of outcomes: a systematic review and meta-analysis using surgical pyloroplasty as a comparator group. Surg Endosc 2020; 34: 3352-3367
    CrossrefPubMedSuche in Google Scholar
  • 29 Weusten BLAM, Barret M, Bredenoord AJ. et al. Endoscopic management of gastrointestinal motility disorders – part 1: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2020; 52: 498-515
    Thieme ConnectPubMedSuche in Google Scholar
  • 30 Orenstein SB, Raigani S, Wu YV. et al. Peroral endoscopic myotomy (POEM) leads to similar results in patients with and without prior endoscopic or surgical therapy. Surg Endosc 2015; 29: 1064-1070
    CrossrefPubMedSuche in Google Scholar
  • 31 Sharata A, Kurian AA, Dunst CM. et al. Peroral endoscopic myotomy (POEM) is safe and effective in the setting of prior endoscopic intervention. J Gastrointest Surg 2013; 17: 1188-1192
    CrossrefPubMedSuche in Google Scholar
  • 32 Zhang H, Zhang J, Jiang A. et al. Gastric peroral endoscopic myotomy for gastroparesis: a systematic review of efficacy and safety. Gastroenterol Hepatol 2019; 42: 413-422
    CrossrefPubMedSuche in Google Scholar
  • 33 Gonzalez J-M, Lestelle V, Benezech A. et al. Gastric per-oral endoscopic myotomy with antropyloromyotomy in the treatment of refractory gastroparesis: clinical experience with follow-up and scintigraphic evaluation (with video). Gastrointest Endosc 2017; 85: 132-139
    CrossrefPubMedSuche in Google Scholar
  • 34 Kahaleh M, Gonzalez J-M, Xu M-M. et al. Gastric peroral endoscopic myotomy for the treatment of refractory gastroparesis: a multicenter international experience. Endoscopy 2018; 50: 1053-1058
    Thieme ConnectPubMedSuche in Google Scholar