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DOI: 10.1055/a-2290-0502
Quantification of interstitial cells of Cajal and fibrosis during gastric per-oral endoscopic myotomy and its association with clinical outcomes
Clinical Trial: Registration number (trial ID): NCT05905016, Trial registry: ClinicalTrials.gov (http://www.clinicaltrials.gov/), Type of Study: Prospective![](https://www.thieme-connect.de/media/10.1055-s-00025476/202404/lookinside/thumbnails/10-1055-a-2290-0502-1.jpg)
Abstract
Background and study aims Alterations to interstitial cells of Cajal (ICC) and collagen fibrosis have been implicated in the pathogenesis of gastroparesis. We aimed to evaluate the feasibility and safety of pyloric muscle sampling during gastric peroral endoscopic myotomy (G-POEM) and the association between pyloric ICC density and degree of fibrosis with clinical outcomes.
Patients and methods This was a single-center prospective study of gastroparetic patients who underwent G-POEM and intraprocedural pyloric muscle biopsies between January 2022 and April 2023. ICC count was estimated using CD117 stain and trichome for collagen fibrosis. Clinical response to G-POEM was defined as an improvement of ≥ 1 point on the Gastroparesis Cardinal Symptom Index.
Results Fifty-six patients (median age 60 years, 71.4% women) underwent G-POEM (100% technical success; 71.4% clinical response). ICC depletion (< 10/high-power field) and fibrosis were encountered in 70.4% and 75% of the cases, respectively. There was no difference in mean ICC count between G-POEM responders vs. non-responders (7±3.6 vs. 7.7±3.3; P= 0.9). There was no association between ICC density or degree of fibrosis with the etiology of gastroparesis, duration of symptoms, gastric emptying rate, or pyloric impedance planimetry. Patients who did not respond to G-POEM had a significantly higher degree of moderate/severe fibrosis when compared with those who responded (81.3% vs. 25%; P = 0.0002).
Conclusions Pyloric muscle biopsies during G-POEM was feasible and safe. ICC depletion and pyloric muscle fibrosis are common in gastroparetic patients. The degree of fibrosis may be related to pyloric dysfunction and clinical response to G-POEM. Additional studies are needed to confirm these results.
Publication History
Received: 03 January 2024
Accepted after revision: 04 March 2024
Accepted Manuscript online:
18 March 2024
Article published online:
23 April 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Georg Thieme Verlag KG
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References
- 1 Khashab MA, Wang AY, Cai Q. AGA Clinical Practice Update on Gastric Peroral Endoscopic Myotomy for Gastroparesis: Commentary. Gastroenterology 2023; 164: 1329-1335 DOI: 10.1053/j.gastro.2023.02.027. (PMID: 37086247)
- 2 Wadhwa V, Mehta D, Jobanputra Y. et al. Healthcare utilization and costs associated with gastroparesis. World J Gastroenterol 2017; 23: 4428-4436
- 3 Grover M, Farrugia G, Stanghellini V. Gastroparesis: a turning point in understanding and treatment. Gut 2019; 68: 2238-2250 DOI: 10.1136/gutjnl-2019-318712. (PMID: 31563877)
- 4 Lacy BE, Tack J, Gyawali CP. AGA Clinical Practice Update on management of medically refractory gastroparesis: expert review. Clin Gastroenterol Hepatol 2022; 20: 491-500 DOI: 10.1016/j.cgh.2021.10.038. (PMID: 34757197)
- 5 Martinek J, Hustak R, Mares J. et al. Endoscopic pyloromyotomy for the treatment of severe and refractory gastroparesis: a pilot, randomized, sham-controlled trial. Gut 2022; 71: 2170-2178
- 6 Kamal F, Khan MA, Lee-Smith W. et al. Systematic review with meta-analysis: one-year outcomes of gastric peroral endoscopic myotomy for refractory gastroparesis. Aliment Pharmacol Ther 2022; 55: 168-177
- 7 Labonde A, Lades G, Debourdeau A. et al. Gastric peroral endoscopic myotomy in refractory gastroparesis: long-term outcomes and predictive score to improve patient selection. Gastrointest Endosc 2022; 96: 500-508 DOI: 10.1016/j.gie.2022.04.002. (PMID: 35413333)
- 8 Vosoughi K, Ichkhanian Y, Jacques J. et al. Role of endoscopic functional luminal imaging probe in predicting the outcome of gastric peroral endoscopic pyloromyotomy (with video). Gastrointest Endosc 2020; 91: 1289-1299
- 9 Takaki M. Gut pacemaker cell: the interstitial cells of Cajal (ICC). J Smooth Muscle Res 2003; 39: 137-161 DOI: 10.1540/jsmr.39.137. (PMID: 14695026)
- 10 Bashashati M, McCallum RW. Is interstitial cells of Cajal (ICC)-opathy present in gastroparesis?. Journal of neurogastroenterology and motility 2015; 12: 486-493 DOI: 10.5056/jnm15075. (PMID: 26424037)
- 11 Langer JC, Berezin I, Daniel EE. Hypertrophic pyloric stenosis: ultrastructural abnormalities of enteric nerves and the interstitial cells of Cajal. J Pediatr Surg 1995; 30: 1535-1543 DOI: 10.1016/0022-3468(95)90151-5. (PMID: 8583319)
- 12 Lin Z, Sarosiek I, Forster J. et al. Association of the status of interstitial cells of Cajal and electrogastrogram parameters, gastric emptying and symptoms in patients with gastroparesis. Neurogastroenterol Motil 2010; 22: 56-61
- 13 Forster J, Damjanov I, Lin Z. et al. Absence of the interstitial cells of Cajal in patients with gastroparesis and correlation with clinical findings. J Gastrointest Surg 2005; 9: 102-108
- 14 Camilleri M, Sanders KM. Gastroparesis. Gastroenterology 2022; 162: 68-87 DOI: 10.1053/j.gastro.2021.10.028. (PMID: 34717924)
- 15 Moraveji S, Bashashati M, Elhanafi S. et al. Depleted interstitial cells of Cajal and fibrosis in the pylorus: Novel features of gastroparesis. Neurogastroenterol Motil 2016; 28: 1048-1054 DOI: 10.1111/nmo.12806. (PMID: 26940535)
- 16 Shah R, Calderon LF, Sanders BE. et al. Quantification of interstitial cells of Cajal in the gastric muscle of patients with gastroparesis at per-oral endoscopic pyloromyotomy: a novel approach for future research in pathogenesis of gastroparesis. Dig Dis Sci 2022; 67: 4492-4499
- 17 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 DOI: 10.1023/B:QURE.0000021689.86296.e4. (PMID: 15129893)
- 18 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 Nuclear Medicine. Am J Gastroenterol 2008; 103: 753-763 DOI: 10.1111/j.1572-0241.2007.01636.x. (PMID: 18028513)
- 19 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
- 20 Hayat M, Yang D, Draganov PV. Third-space endoscopy: the final frontier. Gastroenterol Rep 2023; 11: goac077 DOI: 10.1093/gastro/goac077. (PMID: 36632624)
- 21 Khan HM, Brar TS, Hasan MK. et al. Prospective study on the efficacy of endoscopic through-the-scope tack and suture system for gastric peroral endoscopic myotomy mucosal incision site closure. Endosc Int Open 2023; 11: E187-E192 DOI: 10.1055/a-1978-6842. (PMID: 36845274)
- 22 Yang D, Kadkhodayan K, Arain MA. et al. Novel dual-action tissue through-the-scope clip for endoscopic closure. VideoGIE 2022; 7: 345-347 DOI: 10.1016/j.vgie.2022.07.004. (PMID: 36238804)
- 23 Uemura KL, Chaves D, Bernardo WM. et al. peroral endoscopic pyloromyotomy for gastroparesis: a systematic review and meta-analysis. Endosc Int Open 2020; 8: E911-E923 DOI: 10.1055/a-1119-6616. (PMID: 32617395)
- 24 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
- 25 Nass KJ, Zwager LW, van der Vlugt M. et al. Novel classification for adverse events in GI endoscopy: the AGREE classification. Gastrointest Endosc 2022; 95: 1078-1085 DOI: 10.1016/j.gie.2021.11.038. (PMID: 34890695)
- 26 Huizinga JD, Chen JH. Interstitial cells of Cajal: update on basic and clinical science. Curr Gastroenterol Rep 2014; 16: 363 DOI: 10.1007/s11894-013-0363-z. (PMID: 24408748)
- 27 Choi KM, Gibbons SJ, Roeder JL. et al. Regulation of interstitial cells of Cajal in the mouse gastric body by neuronal nitric oxide. Neurogastroenterol Motil 2007; 19: 585-595 DOI: 10.1111/j.1365-2982.2007.00936.x. (PMID: 17593140)