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Gourcerol G, Gonzalez JM, Bonaz B, Fontaine S, Zerbib F, Mion F, Basile P, Gillibert A, Labonde A, Soliman H, Vitton V, Coffin B, Jacques J. Gastric electrical stimulation versus per-oral pyloromyotomy for the treatment of nausea and vomiting associated with gastroparesis: An observational study of two cohorts. Neurogastroenterol Motil 2023:e14565. [PMID: 36961085 DOI: 10.1111/nmo.14565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 02/21/2023] [Accepted: 03/10/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Both gastric electrical stimulation (GES) and gastric-peroral endoscopic myotomy (G-POEM) can be offered to patients with gastroparesis and predominant nausea and vomiting. The study's aim was to compare GES and G-POEM efficacy on nausea and vomiting scores in patients with gastroparesis. METHODS Two multicenter cohorts of patients with medically refractory gastroparesis with predominant nausea and vomiting (defined as a score >2 on nausea and vomiting subscale that varied from 0 to 4) were treated either with GES (n = 34) or G-POEM (n = 30) and were followed for 24 months (M). Clinical response was defined as a decrease of ≥1 point in nausea and vomiting subscale without premature exclusion due to switch from one to the other technique before M24. Changes in symptomatic scales and quality of life were also monitored. KEY RESULTS Patients from both groups were comparable although the mean score of nausea and vomiting subscale was higher in GES (3.0) compared to G-POEM group (2.6; p = 0.01). At M24, clinical response was achieved in 21/34 (61.7%) patients with GES and in 21/30 (70.0%; p = 0.60) patients with G-POEM. Mean scores of nausea and vomiting subscale decreased at M24 in both GES (from 3.0 to 1.6; p < 0.001) and G-POEM (from 2.6 to 1.2; p < 0.001) groups, although there was no difference between groups (difference adjusted from baseline: -0.28 [-0.77; 0.19]; p = 0.24). Likewise, symptomatic and quality of life scores improved at M24 in both groups, without difference according to treatment group. CONCLUSIONS AND INFERENCES At M24, we did not observe significant difference in efficacy of GES and G-POEM in medically refractory gastroparesis with predominant nausea and vomiting.
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Affiliation(s)
- Guillaume Gourcerol
- Physiology and Gastroenterology Department, INSERM 1073-CIC 1404, RouenUniversity Hospital, Rouen, France
| | | | - Bruno Bonaz
- Gastroenterology Department CHU, Grenoble, France
| | | | - Frank Zerbib
- Gastroenterology Department, Centre Medico-chirurgical Magellan, INSERM CIC 1401, CHU de Bordeaux, Hôpital Haut-Lévêque, Université de Bordeaux, Bordeaux, France
| | | | - Paul Basile
- Physiology and Gastroenterology Department, INSERM 1073-CIC 1404, RouenUniversity Hospital, Rouen, France
| | - André Gillibert
- Biostatistic Department, Rouen University Hospital, Rouen, France
| | | | - Heithem Soliman
- Gastroenterology Department, Université de Paris, AP-HP, Hopital Louis Mourier, DMU ESPRIT, Colombes, France
| | - Véronique Vitton
- Gastroenterology Department, North Hospital AP-HM, Marseille, France
| | - Benoit Coffin
- Gastroenterology Department, Université de Paris, AP-HP, Hopital Louis Mourier, DMU ESPRIT, Colombes, France
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Labonde A, Lades G, Debourdeau A, Ragi O, Lehmann L, Vitton V, Barthet M, Legros R, Albouys J, Geyl S, Loustaud-Ratti V, Monteil J, Gonzalez S, Gonzalez JM, Jacques J. Gastric peroral endoscopic myotomy in refractory gastroparesis: long-term outcomes and predictive score to improve patient selection. Gastrointest Endosc 2022; 96:500-508.e2. [PMID: 35413333 DOI: 10.1016/j.gie.2022.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 04/03/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Limited data exist concerning the long-term efficiency of gastric peroral endoscopic myotomy (G-POEM) as a treatment of refractory gastroparesis. This study evaluated the 3-year results of G-POEM in patients with refractory gastroparesis. METHODS This was a prospective multicenter study of all G-POEM operations performed in 2 expert French centers for 46 patients with refractory gastroparesis with at least 3 years of follow-up. RESULTS Clinical success was 65.2% at 36 months. There was significant improvement in symptom severity. Median Gastroparesis Cardinal Symptom Index decreased from 3.33 to 1.80 (P < .0001), with improvement in all subscales. We created a predictive score concerning G-POEM success (G-POEM predictive score) to which points were assigned as follows: nausea subscale <2: predictive of success, 1 point; satiety subscale >4: predictive of success, 1 point; bloating subscale >3.5: predictive of success, 1 point; percentage of gastric retention at 4 hours on scintigraphy >50%: 1 point. A threshold of 2 was identified by receiver operating characteristic curve analysis with an area under the curve of .825 that predicted clinical success with a sensitivity of 93.3% (95% confidence interval [CI], .77-.99), specificity of 56.3% (95% CI, .33-.77), positive predictive value of 80% (95% CI, .67-.93), negative predictive value of 81.8% (95% CI, .59-1.00), and accuracy of 80.4% (95% CI, .69-.92). Patients with a score ≥2 were significantly more likely to be responders at 3 years than were patients with a score <2 (80% and 18%, respectively; P = .0004). CONCLUSIONS The clinical success of G-POEM for refractory gastroparesis was 65.2% at 36 months. Our predictive score offers an easy tool that needs to be confirmed in other studies.
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Affiliation(s)
- Amélie Labonde
- Service d'Hépato-gastro-entérologie, CHU Limoges, Limoges, France
| | | | - Antoine Debourdeau
- Service d'Hépato-gastro-entérologie, CHU Montpellier, Montpellier, France
| | - Olivier Ragi
- Service d'Hépato-gastro-entérologie, CHU Lyon, Lyon, France
| | - Lauriane Lehmann
- Service d'Hépato-gastro-entérologie, Polyclinique de Limoges, Limoges, France
| | - Véronique Vitton
- Service d'Hépato-gastro-entérologie, APHM Hôpital Nord, Marseille, France
| | - Marc Barthet
- Service d'Hépato-gastro-entérologie, APHM Hôpital Nord, Marseille, France
| | - Romain Legros
- Service d'Hépato-gastro-entérologie, CHU Limoges, Limoges, France
| | - Jérémie Albouys
- Service d'Hépato-gastro-entérologie, CHU Limoges, Limoges, France
| | - Sophie Geyl
- Service d'Hépato-gastro-entérologie, CHU Limoges, Limoges, France
| | | | - Jacques Monteil
- Service d'Hépato-gastro-entérologie, CHU Limoges, Limoges, France
| | - Sandra Gonzalez
- Service de médecine nucléaire, APHM Hôpital Nord, Marseille, France
| | | | - Jérémie Jacques
- Service d'Hépato-gastro-entérologie, CHU Limoges, Limoges, France.
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Labonde A, Jacques J, Gonzalez JM, Jésus P. Évolution du statut nutritionnel et de la symptomatologie des patients avec une gastroparésie traitée par pylorotomie endoscopique, étude à 36 mois. NUTR CLIN METAB 2022. [DOI: 10.1016/j.nupar.2021.12.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hallab M, Bourgeais G, Labonde A, Leftheriotis G, Belizna C. Épaisseur intima-média et rigidité artérielle : corrélations avec les titres des aPL dans le SAPL primaire. Rev Med Interne 2014. [DOI: 10.1016/j.revmed.2014.03.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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