Gastric peroral endoscopic myotomy (G-POEM) for refractory gastroparesis: 3-month follow-up results

Prognostic value of preoperative intragastric meal distribution in gastric emptying scintigraphy for long-term success of gastric peroral endoscopic myotomy in gastroparesis

BACKGROUND AND AIMS

Gastric emptying scintigraphy (GES) is the criterion standard for the diagnosis of gastroparesis. However, data are lacking regarding the prognostic value of preoperative intragastric meal distribution during GES in patients undergoing gastric peroral endoscopic myotomy (G-POEM) for gastroparesis. This study investigated the association of GES morphologic parameters and the long-term clinical success of G-POEM.

METHODS

This retrospective study included patients who underwent G-POEM for refractory gastroparesis in a tertiary center with preoperative GES data. Intragastric meal distribution was measured using the proximal to distal count ratio (PDCR) at 0, 1, 2 and 4 hours, and the retention index was calculated. Clinical success was defined as a decrease of at least 50% in the Gastroparesis Cardinal Symptom Index total score after G-POEM.

RESULTS

In total, 77 patients were included with a mean follow-up of 40.14 months. Clinical success was observed in 54.55% of patients. The retention index was not associated with clinical success. Only PDCR at 0 hours (PDCR0) was associated with clinical success. In univariate analysis, the median PDCR0 was 6.0 (interquartile range, 5.59) in patients with clinical success and 4.29 (interquartile range, 4.51) in patients with clinical failure (P = .019). In multivariate analysis, PDCR0 >5.25 was associated with clinical success (odds ratio, 4.36; 95% confidence interval, 1.55-12.26; P = .00524).

CONCLUSIONS

This study suggests that in patients with gastroparesis, a high PDCR0 value (suggestive for a preferential fundic meal distribution) during preoperative GES is associated with long-term clinical response to G-POEM.

Efficacy and Safety of Gastric Per-Oral Endoscopic Myotomy (G-POEM): A Systematic Review and Meta-Analysis

BACKGROUND

Gastric per-oral endoscopic myotomy (G-POEM) is an innovative treatment that has become increasingly utilized for patients with refractory gastroparesis. The aim of this systematic review and meta-analysis was to evaluate the safety and effectiveness of G-POEM for the treatment of gastroparesis.

METHODS

Individualized search strategies were developed through February 2021 in accordance with the PRISMA and MOOSE guidelines. This meta-analysis was performed by calculating pooled proportions and mean difference preprocedure and postprocedure with rates estimated using random effects models. Measured outcomes included technical success, clinical success, improvement in gastroparesis cardinal symptom index (GCSI), change in gastric emptying rate, alterations in impedance planimetry (functional lumen imaging probe [FLIP]) assessment, and adverse events.

RESULTS

A total of 20 studies (n=797 patients; 67.41% female) were included. The mean age was 48.92±11.61 y, with an average duration of 4.24±1.11 y since gastroparesis diagnosis. Technical success was 98.47% [(95% CI: 97.14, 99.19);I2=0.00] with a mean myotomy length of 3.78±1.16 cm. In terms of clinical success, mean preprocedure GCSI scores were 3.38±0.37 and improved significantly postprocedure [weighted mean difference -1.56 (95% CI: -1.89 to -1.24); I2=82.53; P<0.001]. Gastric retention after 4 hours demonstrated ~50% improvement (preprocedure 43.08±9.24% versus postprocedure 22.97±10.19%; P<0.001). FLIP assessment with 40 mL and 50 mL balloons demonstrated a significant increase in diameter, distensibility index, and cross-sectional area postprocedure (all P<0.05). Procedure-associated adverse events occurred among 10.92% [(95% CI 5.09 to 19.32); I2=82.85] of patients.

CONCLUSION

G-POEM appears safe and highly effective for the treatment of patients with refractory gastroparesis regardless of symptom predominance or etiology.