Gastric per‐oral endoscopic myotomy versus pyloromyotomy for gastroparesis: An international comparative study

Abstract

Background and Aim: Gastroparesis is a potentially debilitating gastric motility disorder with limited treatment options. Highest efficacy treatments include gastric per-oral endoscopic myotomy (GPOEM) and surgical pyloromyotomy. This study compares the efficacy and safety of GPOEM versus laparoscopic pyloromyotomy for refractory gastroparesis. Methods: Patients who underwent GPOEM or laparoscopic pyloromyotomy for refractory gastroparesis from four centers across the USA and Latin America were included in a dedicated registry. Data collected included patient demographics, imaging, laboratory values, clinical success, gastroparesis cardinal symptom index, procedure time, pre-op and post-op gastric emptying times, adverse events, and hospital length of stay. Results: A total of 102 patients were included (mean age 47; 32.4% male): GPOEM n = 39, surgical pyloromyotomy n = 63.Technical success was 100% in both groups. Clinical success was 92.3% in the GPOEM group and 82.5% in the surgery group (P = 0.164). The GPOEM group had a significantly higher post-op GSCI score reduction by 1.3 units (P < 0.00001), post-op retention reduction at 2 h by 18% (P < 0.00001), post-op retention reduction at 4 h by 25% (P < 0.00001) and a lower procedure time by 20 min (P < 0.00001) as compared with surgery. GPOEM also had a lower hospital length of stay by 2.8 days (P < 0.00001). Adverse events were significantly fewer in the GPOEM group (13%) compared with surgery group (33.3%; P = 0.021). Mean blood loss in the GPOEM group was only 3.6 mL compared with 866 mL in the surgery group. Conclusions: The GPOEM may be a less invasive, safer, and more efficacious procedural treatment for refractory gastroparesis as compared with surgical pyloromyotomy. Cook, Apollo, NinePoint Medical, and Merit. He has done research and consulting for Boston Scientific. Avik Sarkar has done consulting work for US Endoscopy and Obalon Therapeutics. Haroon Shahid has done consulting work for US Endoscopy.

Gastric peroral endoscopic myotomy versus surgical pyloromyotomy/pyloroplasty for refractory gastroparesis: systematic review and meta-analysis

“…After rigorous screening, a total of 4 studies (1 abstract and 3 full texts) were selected for inclusion in the meta-analysis. [ 14 , 15 , 16 , 17 ] The details of study selection are highlighted in the PRISM flow diagram (Figure 1). Of the included studies, all were observational.…”

“…The muscle fibers are spread with a spreader and pyloric edges are mobilized thus confirming successful pyloromyotomy. [16] In pyloroplasty, a longitudinal incision is performed through the pylorus and the incision is then closed using Heineke-Mikulicz technique. [15] A previous retrospective study comparing these two techniques in children with delayed gastric emptying and gastroesophageal reflux did not find an advantage of one over the other.…”

Targeting the pylorus in gastroparesis: From physiology to endoscopic pyloromyotomy

“…Pyloroplasty was associated with a longer length of stay and a higher rate of complications (16.7% vs. 3.3%; p = 0.086), suggesting that the endoscopic procedure should be favored over the surgical approach. A second multicenter study compared G‐POEM with pyloromyotomy and included 102 patients (39 with G‐POEM and 63 with surgery) 103 . This study ended up with similar results, since the efficacy did not differ between the two procedures, although fewer adverse events were reported in the G‐POEM group (13% vs. 33%; p = 0.02) 103 .…”

Submucosal endoscopy: the present and future

“…Limited data indicate that G-POEM may be superior to GES and equally effective to surgical pyloroplasty with the advantage of fewer AEs. [71][72][73] 2) Subepithelial tumors (STER) Endoscopic resection techniques for SETs in the upper GI tract include endoscopic submucosal dissection, endoscopic submucosal excavation (ESE), endoscopic full-thickness resection, and STER. Of these, STER utilizes the principles of SEMF for resection of upper GI SETs (Fig.…”

“…Limited data indicate that G-POEM may be superior to GES and equally effective to surgical pyloroplasty with the advantage of fewer AEs. 71 - 73 …”