The application of an enamel matrix protein derivative (Emdogain) in regenerative periodontal therapy: a review.

Contains fulltext : 53648.pdf (publisher's version ) (Open Access)Regenerative periodontal therapy aims at reconstitution of the lost periodontal structures such as new formation of root cementum, periodontal ligament and alveolar bone. Findings from basic research indicate that enamel matrix protein derivative (EMD) has a key role in periodontal wound healing. Histological results from animal and human studies have shown that treatment with EMD promotes periodontal regeneration. Moreover, clinical studies have indicated that treatment with EMD positively influences periodontal wound healing in humans. This review aims to present an overview of evidence-based clinical indications for regenerative therapy with EMD

Gastric Peroral Endoscopic Myotomy for Management of Refractory Gastroparesis in Patients with Gastric Neurostimulator Devices: A Multicenter Retrospective Case Control Study

BACKGROUND AND AIMS: Gastric neurostimulation (GNS) and gastric peroral myotomy (G-POEM), therapies for refractory gastroparesis, are associated with suboptimal outcomes. We studied the role of G-POEM as a salvage therapy in patients with refractory symptoms after GNS implantation. METHODS: This was a multicenter, retrospective, matched-case control study. Consecutive patients with GNS device and underwent G-POEM as a salvage therapy for clinical failure (cases) and patients without GNS implantation and underwent G-POEM for refractory gastroparesis (control) between 10-2018 and 08-2021 were included. The primary outcome was clinical success after G-POEM. RESULTS: A total of 123 patients (mean age 45.7 ± 14.7 years; 88 females [72%]) underwent G-POEM therapy during the duration of the study: 41 cases and 82 controls. Clinical success was achieved in 66% in the case group and 65% in the control, (P=0.311), during a median total clinical follow-up time of 11.8 (IQR: 2.4-6.3) months. In the case group, the mean Gastroparesis Cardinal Symptom Index (GCSI) decreased from 2.8 ± 1.8 to 1.5 ± 1.9, (P=0.024), and gastric retention at 4 hours improved from 45% ± 25.8 to 16.6% ± 13.1, (P=0.06). The mean delta improvement in the subscales of nausea/vomiting (1.3 ± 0.6 vs. 0.9 ± 1.1; P=0.044) and bloating (1.6 ± 1.3 vs. 1.2 ± 1.4; P=0.041) were significantly higher in cases than in controls. CONCLUSIONS: Among patients with refractory symptoms after GNS, G-POEM can be a reasonable salvage therapy to provide further symptomatic relief with evidence of a potential additive effect of both G-POEM and GNS

Gastric peroral endoscopic myotomy for management of refractory gastroparesis in patients with gastric neurostimulator devices: a multicenter retrospective case control study

Background and Aims Gastric neurostimulation (GNS) and gastric peroral myotomy (G-POEM), therapies for refractory gastroparesis, are associated with suboptimal outcomes. We studied the role of G-POEM as a salvage therapy in patients with refractory symptoms after GNS implantation. Methods This was a multicenter, retrospective, matched case-control study. Consecutive patients with a GNS device and who underwent G-POEM as a salvage therapy for clinical failure (cases) and patients without GNS implantation and who underwent G-POEM for refractory gastroparesis (control) between October 2018 and August 2021 were included. The primary outcome was clinical success after G-POEM. Results A total of 123 patients (mean age 45.7 ± 14.7 years; 88 female subjects [72%]) underwent G-POEM therapy during the study: 41 cases and 82 controls. Clinical success was achieved in 66% in the case group and 65% in the control group (P = .311), during a median total clinical follow-up time of 11.8 (interquartile range, 2.4-6.3) months. In the case group, the mean Gastroparesis Cardinal Symptom Index score decreased from 2.8 ± 1.8 to 1.5 ± 1.9 (P = .024), and gastric retention at 4 hours improved from 45% ± 25.8% to 16.6% ± 13.1% (P = .06). The mean delta improvement in the subscales of nausea/vomiting (1.3 ± .6 vs .9 ± 1.1, P = .044) and bloating (1.6 ± 1.3 vs 1.2 ± 1.4, P = .041) were significantly higher in cases than in controls. Conclusions Among patients with refractory symptoms after GNS, G-POEM can be a reasonable salvage therapy to provide further symptomatic relief with evidence of a potential additive effect of both G-POEM and GNS. Abbreviations

Management of Patients After Failed Gastric Peroral Endoscopic Myotomy: A Multi-Center Study

Introduction: The heterogeneous and unpredictable clinical outcomes of gastric peroral endoscopic myotomy (G-POEM) in patients with refractory gastroparesis is a fundamental shortcoming of the procedure. The optimal management of patients who fail G-POEM is not known. We aimed to compare the outcomes of different management strategies in patients who had failed G-POEM. Methods: This was a multicenter retrospective study at 7 tertiary centers between 02/2020 and 10/2022. All patients who underwent G-POEM and experienced persistent (primary) or recurrent (secondary) symptoms were labeled as clinical failure and were included. Primary outcome was clinical success post re-treatment, defined as a 1-score decrease in average Gastroparesis Cardinal Symptom Index (GCSI) with a ≥ 25% decrease in at least 2 sub-scales post-G-POEM. Results: A total of 233 patients [mean age 47.8 ± 15.6, F 170 (73%)] underwent G-POEM for the management of refractory gastroparesis at 7 U.S. tertiary care centers, and 92 (39%) patients experienced clinical failure with a median GCSI score of 2.4 (IQR 2.1-3.3). The majority, 86 (93%), were primary clinical failures. Post-G-POEM GES was performed in 35 (38%) [abnormal in 14 (40%)], and diagnostic upper endoscopy in 57 (62%) [endoscopic findings suggestive of gastroparesis 35 (83%)]. During the duration of the study, a total of 25 (27%) underwent re-treatment, while 67 (73%) underwent pharmacologic and/or palliative symptomatic treatment (Table 1). Among the patients who underwent re-treatment, clinical success was achieved in 12 (46%) of the patients during a median duration follow-up of 9.4 (IQR 6-13) months, with a decrease in the median GCSI score from 2.8 ± 1.6 to 1.5 ± 1.8, (P = 0.024). A total of 9 patients in the re-treatment group underwent both pre- and post-retreatment GES with an improvement in gastric retention at 4 hrs. from 38 ± 20.83 % to 23 ± 19.7 %, (P = 0.124). The highest clinical success was achieved among patients with GNS, 5 (83%), followed by repeat G-POEM, 4 (67%) (Figure 1). Having abnormal GES post-G-POEM was found to be the only independent predicting factor (OR 1.6, P = 0.031) for clinical success post-re-treatment. Concomitant gastrointestinal pathologies were noted in 6 (6.5%) (esophageal dysmotility treatment 2, sphincter of Oddi dysfunction 1, candida esophagitis 3). Conclusion: In our cohort, 46% of patients with clinical failure post-G-POEM had clinical success after re-treatment, with abnormal GES post-failed G-POEM being a predictor of clinical response