简介：AbstractBackground:Gastroparesis is a debilitating medical condition with limited treatment options. Gastric per-oral pyloromyotomy (G-POEM) has emerged as a promising treatment option with remarkable short-term clinical success shown in multiple studies. While the post-procedure protocol is not standardized across many centers, the majority of the centers observes these patients in the hospital after the procedure for monitoring. In this single-center prospective study, we evaluated the safety and feasibility of same day discharge after the G-POEM procedure.Methods:All the patients with refractory gastroparesis undergoing G-POEM from October 2019 to March 2020 were enrolled. A total of 25 patients were enrolled in the procedure. Based on the pre-defined criteria, patients were either discharged on the same day after the procedure or admitted to the hospital for further observation. The patient and procedure-related data were extracted from the chart review. Univariate analysis was performed (chi-squared test) on categorical variables after organizing categorical variables as numeric counts or percentages. The student t test was performed on continuous variables after reporting as mean and standard deviation. For analysis with a smaller sample size, Fisher exact and Mann–Whitney tests were used.Results:A total of 25 patients were enrolled. The technical success of G-POEM was 100% and clinical success was 80% (20/25) at 1-month follow-up. Of the 25 patients, 9 patients (36%) were discharged on the same day according to the procedure from the recovery unit. Of the remaining 16 patients who were admitted to the hospital post-procedure, 10 (40%) were admitted due to procedure-related causes while other admissions were either pre-planned or due to social reasons. The average Charlson comorbidity index was lower in the same day discharge group (P < 0.05). The number of patients requiring double myotomy was higher in the same day discharge group (P < 0.05). The overall complication rate of G-POEM in the study cohort was 12% (3/25) with all complications being mild without any severe adverse events.Conclusion:G-POEM is a safe and effective method of treatment for refractory GP with higher clinical success in short-term follow-up. The same day discharge after G-POEM is safe and feasible in >50% of patients with close periprocedural monitoring.

简介：摘要目的探讨食管癌肿瘤细胞中Per2、HDAC1、E－钙黏蛋白mRNA表达及其意义。方法采用实验研究方法。体外培养人食管癌细胞系KYSE－150细胞至对数生长期设为实验组，体外培养人正常食管上皮细胞至对数生长期设为对照组。观察指标：(1)细胞增殖活力。(2)细胞迁移和侵袭能力情况。(3)初始生理状态下Per2、HDAC1、E－钙黏蛋白mRNA表达情况。(4)Per2激动剂和抑制剂处理后Per2、HDAC1、E－钙黏蛋白mRNA表达情况。(5)HDAC1抑制剂处理后Per2、E－钙黏蛋白mRNA表达情况。正态分布的计量资料以±s表示，组内比较采用t检验；组间比较采用t检验或协方差分析。结果(1)细胞增殖活力：实验组和对照组细胞增殖活力分别为0.90%±0.14%和0.52%±0.08%，两组比较，差异有统计学意义(t＝5.166，P<0.05)。(2)细胞迁移和侵袭能力情况：实验组和对照组发生迁移细胞数分别为(173±41)个和(50±15)个，两组比较，差异有统计学意义(t＝6.274，P<0.05)。实验组和对照组发生侵袭细胞数分别为(86±27)个和(21±9)个，两组比较，差异有统计学意义(t＝5.153，P<0.05)。(3)初始生理状态下Per2、HDAC1、E－钙黏蛋白mRNA表达情况：初始生理状态下，实验组细胞Per2、HDAC1、E－钙黏蛋白mRNA表达水平分别为11.7±2.7、20.4±6.6、12.4±2.5；对照组细胞上述指标分别为2.4±0.5、8.5±2.2、27.3±4.5，两组比较，差异均有统计学意义(t＝5.782，2.982，－5.034，P<0.05)。(4)Per2激动剂和抑制剂处理后Per2、HDAC1、E－钙黏蛋白mRNA表达情况：Per2激动剂处理后，实验组细胞Per2、HDAC1、E－钙黏蛋白mRNA表达水平分别为13.1±2.2、22.4±6.2、16.6±4.2；对照组细胞上述指标分别为9.9±3.1、18.4±5.6、15.3±2.3。实验组细胞Per2激动剂处理后上述指标与初始生理状态下比较，差异均无统计学意义(t＝－4.300，10.087，－4.187，P>0.05)；对照组细胞Per2激动剂处理后上述指标与初始生理状态下比较，差异均有统计学意义(t＝－4.846，3.501，9.294，P<0.05)。Per2激动剂处理后，两组细胞Per2和E－钙黏蛋白mRNA表达水平比较，差异均无统计学意义(F＝1.000，7.582，P>0.05)；两组细胞HDAC1 mRNA表达水平比较，差异有统计学意义(F＝1.724，P<0.05)。Per2抑制剂处理后，实验组细胞Per2、HDAC1、E－钙黏蛋白mRNA表达水平分别为4.1±1.7、7.5±2.2、22.8±4.2；对照组细胞上述指标分别为3.1±0.9、9.3±3.2、28.4±5.8。实验组细胞Per2抑制剂处理后上述指标与初始生理状态下比较，差异均有统计学意义(t＝12.124，5.105，－10.245，P<0.05)；对照组细胞Per2抑制剂处理后上述指标与初始生理状态下比较，差异均无统计学意义(t＝－2.815，1.568，－1.439，P>0.05)。Per2抑制剂处理后，两组细胞Per2和E－钙黏蛋白mRNA表达水平比较，差异均有统计学意义(F＝22.965，82.134，P<0.05)；两组细胞HDAC1 mRNA表达水平比较，差异无统计学意义(F＝6.416，P>0.05)。(5)HDAC1抑制剂处理后Per2、E－钙黏蛋白mRNA表达情况：HDAC1抑制剂处理后，实验组细胞Per2、E－钙黏蛋白mRNA表达水平分别为13.4±3.5、24.2±3.4，对照组细胞上述指标分别为3.1±1.2、26.8±5.2。实验组细胞HDAC1抑制剂处理后Per2 mRNA表达水平与初始生理状态下比较，差异无统计学意义(t＝－3.959，P>0.05)；E－钙黏蛋白mRNA表达水平与初始生理状态下比较，差异有统计学意义(t＝－21.977，P<0.05)。对照组细胞HDAC1抑制剂处理后Per2、E－钙黏蛋白mRNA表达水平与初始生理状态下比较，差异均无统计学意义(t＝－1.440、1.058，P>0.05)。HDAC1抑制剂处理后，两组细胞Per2 mRNA表达水平比较，差异无统计学意义(F＝2.004，P>0.05)，E－钙黏蛋白mRNA表达水平比较，差异有统计学意义(F＝325.800，P<0.05)。结论食管肿瘤细胞中Per2和HDAC1 mRNA表达水平升高，E－钙黏蛋白mRNA表达水平降低。Per2 mRNA高表达可能会激活下游靶向蛋白HDAC1的表达升高，抑制细胞表面E－钙黏蛋白mRNA表达水平。