Gastric Per Oral Endoscopic Myotomy (G-POEM) for the Treatment of Refractory Gastroparesis: Early Experience

Malik, Zubair; Kataria, Rahul; Modayil, Rani J.; Ehrlich, Adam C.; Schey, Ron; Parkman, Henry P.; Stavropoulos, Stavros N.

doi:10.1016/s0016-5085(17)30743-6

Cited by 24 publications

(64 citation statements)

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“…All the studies reported a decrease in the values of GCSI after G-POEM, and we used the longest follow up to calculate this. However, we found one study with publication bias, from Malik et al [24], which was presented as an outlier during the general analysis. The I 2 values dropped from 72 % to 50 % after excluding this study as shown in ▶ Fig.…”

Section: Gcsimentioning

confidence: 76%

“…Among the 10 studies included in this meta-analysis, four were prospective [19][20][21][22], including two published abstracts [20,21], and 6 were retrospective [1,[23][24][25][26][27], including also another abstract [27], which we chose instead of the published article from the same group, because it is more recent and has a larger number of patients [28]. In total, 281 patients were included in this meta-analysis.…”

Section: Study Characteristics and Quality Assessmentmentioning

confidence: 99%

“…Mekaroonkamol et al [23] aimed to identify predictive factors of the clinical response after G-POEM and compared outcomes between diabetes gastroparesis and non-diabetes gastroparesis (NDG). Xue et al [26] performed fluoroscopy-guided G-POEM to direct the orientation of the submucosal tunnel, to facilitate the location of the pyloric muscle ring and shorten the procedure time, while Malik et al and Jacques et al [22,24] used En-doFLIP to determine whether pyloric sphincter characteristics existed that could predict a successful procedure. The remaining authors performed routine G-POEM.…”

Section: Study Characteristics and Quality Assessmentmentioning

confidence: 99%

“…The Xue et al [20] study was not included in this subgroup analysis because the results were described at the 1month follow up. Gonzalez et al [25], Hustak et al [20], Landreneau et al [1], Malik et al [24], Jacques et al [22], Hernandez Mondragon et al [21] and Rodriguez et al [19] reported the mean difference between GCSI before and after 3 months of G-POEM with a 95 % confidence interval as 1.76 [1.26-2.25] by the Cochran Q test (P < 0.0001, I 2 = 81 %). Although the hetero-geneity was high, all the studies showed improvement in the GCSI score after the procedure.…”

Section: Gcsi Subgroupmentioning

confidence: 99%

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Peroral endoscopic pyloromyotomy for gastroparesis: a systematic review and meta-analysis

et al. 2020

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Background and aim Gastric peroral endoscopic pyloromyotomy (G-POEM) is a new therapeutic option for refractory gastroparesis (GP). A systematic review and meta-analysis was conducted to assess the effectiveness of G-POEM in refractory GP. For the quality of evidence, we used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Methods We performed a literature search using MEDLINE, Embase, Cochrane library, LILACS and the Science citation index for studies related to G-POEM from the inception of its technique through January 2019. We selected studies that analyzed the gastroparesis cardinal symptom index (GCSI) and 4-hour solid-phase gastric emptying scintigraphy (GES) before and after the procedure to verify the efficacy of G-POEM, the main outcome measured. An analysis was performed using RevMan 5.3. Results Ten studies comprising 281 patients were included in this systematic review. The pooled mean difference in GCSI following the procedure was 1.76 (95 % CI: [1.43, 2.08], I2 = 72 %). We also performed GCSI subgroup analysis by follow-up duration that showed a pooled mean difference of 1.84 (95 % CI: [1.57, 2.12], I2 = 71 %). The pooled mean difference in GES after the procedure was 26.28 (95 % CI: [19.74, 32.83], I2 = 87 %), corresponding to a significant drop in percentage values of the gastric retention 4-hour scintigraphy. Conclusion This meta-analysis demonstrates that G-POEM is effective and shows promising outcomes in the clinical response and gastric emptying scintigraphy for gastroparesis. Therefore, it should be considered in the management of refractory gastroparesis.

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Section: Gcsimentioning

confidence: 76%

Section: Study Characteristics and Quality Assessmentmentioning

confidence: 99%

Section: Study Characteristics and Quality Assessmentmentioning

confidence: 99%

Section: Gcsi Subgroupmentioning

confidence: 99%

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Peroral endoscopic pyloromyotomy for gastroparesis: a systematic review and meta-analysis

et al. 2020

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“…Eight of 11 patients in follow-up had subjective symptom improvement. 37 In 2018, our group published a retrospective study that compared laparoscopic pyloroplasty (LP) with endoscopic peroral pyloromyotomy (POP). A total of 60 patients were included in this study (30 per group).…”

Section: Clinical Outcomes and Complicationsmentioning

confidence: 99%

Endoscopic Intramural Surgery Part II: Muscular Division

Barajas‐Gamboa¹,

Corcelles²,

Kroh³

2018

Dig Dis Interv

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The development of endoscopic technologies and the introduction of new surgical concepts during the last decade has led to an evolution of surgical treatment of gastrointestinal disorders including achalasia, gastroesophageal reflux, gastroparesis, inflammatory bowel disease, and tumors of the gastrointestinal tract. Intramural surgery creates a novel approach to perform muscular division, submucosal dissection, and tumor removal. These procedures have proven safe and effective, and increasingly are part of the surgical endoscopist's toolbox. Intramural surgical procedures include peroral esophagomyotomy (POEM), peroral pyloromyotomy (POP), Zenker's diverticulotomy, and submucosal tunneling and endoscopic resection (STER) of lesions. The objective of this article is to describe current intramural surgery procedures that comprise muscular division, as well as clinical outcomes and its impact on surgical endoscopic practices.

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Predictors of favorable outcome after pyloroplasty for gastroparesis: should response to pyloric dilation or Botox injection be used as a marker of surgical outcome?

et al. 2023

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Introduction Pyloroplasty and gastric peroral endoscopic myotomy (G-POEM) are effective surgeries for gastroparesis. The primary aim of this study was to evaluate outcomes of pyloroplasty and G-POEM in patients with gastroparesis and determine factors associated with favorable outcome. The secondary aim was to assess the utility of clinical response to preoperative pyloric dilation or botulinum toxin injection (Botox) on surgical outcome, a factor conventionally used as a favorable marker. Methods There were 204 patients who underwent pyloroplasty (n = 177) or G-POEM (n = 27) for gastroparesis at our institution from 2014 to 2021. Demographic and clinical parameters were analyzed to assess their impact on surgical outcome. A subgroup of patients who had pyloric dilation or Botox injection were assessed separately. Favorable outcome was defined as patient reported complete resolution of the predominant gastroparesis symptom. Results Favorable outcome was achieved in 78.4% of patients (pyloroplasty: 79.7% and G-POEM: 70.4%, p = 0.274). Among 61 patients where pre- and postoperative gastric emptying studies (GES) were available, mean 4-hour retention significantly improved from 33.5 to 15.0% (p < 0.001) and 77.0% of patients achieved normalization. Favorable outcome was not significantly impacted by etiology of gastroparesis (p = 0.120), GERD (p = 0.518), or primary gastroparesis symptom (p = 0.244). Age ≥ 40 was a significant predictor of favorable surgical outcome on multivariate analysis [OR: 2.476 (1.224–5.008), p = 0.012]. Among the patients who had preoperative dilation (n = 82) or Botox injection (n = 46), response to these interventions was not a predictor of favorable surgical outcome (p = 0.192 and 0.979, respectively). However, preoperative Botox injection, regardless of response to injection, was associated with favorable surgical outcome [OR: 3.205 (CI 1.105–9.299), p = 0.032]. Conclusion Symptomatic improvement after pyloroplasty or G-POEM is independent of etiology of gastroparesis, GERD, and primary symptom. Response to dilation or Botox are not markers of response to surgery. However, patients who receive Botox are 3.2 times more likely to improve postoperatively. Graphical abstract

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Gastric Per Oral Endoscopic Myotomy (G-POEM) for the Treatment of Refractory Gastroparesis: Early Experience

Cited by 24 publications

References 0 publications

Peroral endoscopic pyloromyotomy for gastroparesis: a systematic review and meta-analysis

Peroral endoscopic pyloromyotomy for gastroparesis: a systematic review and meta-analysis

Endoscopic Intramural Surgery Part II: Muscular Division

Predictors of favorable outcome after pyloroplasty for gastroparesis: should response to pyloric dilation or Botox injection be used as a marker of surgical outcome?

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