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CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(04): E585-E592
DOI: 10.1055/a-2290-0502
Original article

Quantification of interstitial cells of Cajal and fibrosis during gastric per-oral endoscopic myotomy and its association with clinical outcomes

Dennis Yang
1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
,
Muhammad Khalid Hasan
1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
,
BahaAldeen Bani Fawwaz
2   Gastroenterology, AdventHealth Central Florida, Orlando, United States (Ringgold ID: RIN558924)
,
Aimen Farooq
3   Internal Medicine, AdventHealth Central Florida, Orlando, United States (Ringgold ID: RIN558924)
1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
,
Yiyang Zhang
4   Statistics, AdventHealth Central Florida, Orlando, United States (Ringgold ID: RIN558924)
,
Hafiz M Khan
5   Gastroenterology and Hepatology, Staten Island University Hospital, Staten Island, United States (Ringgold ID: RIN7601)
,
Tony S Brar
1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
,
Sanmeet Singh
2   Gastroenterology, AdventHealth Central Florida, Orlando, United States (Ringgold ID: RIN558924)
,
Artur Viana
2   Gastroenterology, AdventHealth Central Florida, Orlando, United States (Ringgold ID: RIN558924)
,
Gurdeep Singh
6   Medicine, AdventHealth Central Florida, Orlando, United States (Ringgold ID: RIN558924)
,
Kambiz Kadkhodayan
1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
,
Mustafa A Arain
1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
,
Natalie Cosgrove
1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
,
Deepanshu Jain
1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
,
Irteza Inayat
2   Gastroenterology, AdventHealth Central Florida, Orlando, United States (Ringgold ID: RIN558924)
,
Charanjeet Singh
7   Pathology, AdventHealth Central Florida, Orlando, United States (Ringgold ID: RIN558924)
› Author Affiliations Clinical Trial: Registration number (trial ID): NCT05905016, Trial registry: ClinicalTrials.gov (http://www.clinicaltrials.gov/), Type of Study: Prospective
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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.

Keywords

POEM - Endoscopy Upper GI Tract - Motility / achalasia - GI Pathology


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
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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