부산대학교 도서관

Key Words gastroesophageal reflux; gastroparesis; lung transplant Abstract Objectives 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. Methods 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. Results 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. Conclusions 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. Abbreviations and Acronyms FEV1, forced expiratory volume in 1 second; GCSI, Gastroparesis Cardinal Symptom Index; GERD, gastroesophageal reflux disease; GET, gastric emptying test; POP, per-oral endoscopic pyloromyotomy Author Affiliation: (a) Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio (b) Department of Gastroenterology, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio (c) Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio (d) Transplant Institute, Cleveland Clinic, Cleveland, Ohio * Address for reprints: Usman Ahmad, MD, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, 9500 Euclid Ave/Desk J4-1, Cleveland, OH 44195. Article History: Received 3 May 2021; Revised 21 September 2021; Accepted 12 October 2021 (footnote) This study was supported in part by the Drs Sidney and Becca Fleischer Heart and Vascular Education Chair and the Daniel and Karen Lee Endowed Chair in Thoracic Surgery. (footnote) Institutional Review Board No. 19-140. Approved February 7, 2019, amendment approved July 7, 2020. Patient consent was waived. Byline: Jesse M.P. Rappaport, MD (a), Siva Raja, MD, PhD (a), Scott Gabbard, MD (b), Lucy Thuita, MS (c), Madhusudhan R. Sanaka, MD (b), Eugene H. Blackstone, MD (a,c), Usman Ahmad, MD [ahmadu@ccf.org] (a,d,*), Atul C. Mehta, MD, Olufemi Akindipe, MD, Charles R. Lane, MD, Shruti Gadre, MD, Marie Budev, DO, MPH, Carli Lehr, MD, Wayne Tsuang, MD, MHS, Jason Turowski, MD, Nora Herceg, Maryam Valapour, MD, MPP, Andrew Tang, MD, Hafiz U. Siddiqui, MD, Amberlee Shaut-Hale, Shinya Unai, MD, James Yun, MD, Haytham Elgharably, MD, Alejandro C. Bribriesco, MD, Sudish C. Murthy, MD, PhD, Kenneth R. McCurry, MD