Gastric Peroral Endoscopic Myotomy (G-POEM) as a Treatment for Refractory Gastroparesis: Long-Term Outcomes

Abstract

Background and Aims Gastric peroral endoscopic myotomy (G-POEM) has been regarded as a novel and minimally invasive therapy for refractory gastroparesis. This study reports the long-term outcomes and possible predictive factors for successful outcomes after G-POEM in an Asian population. Methods This is a retrospective single-centre study of 16 patients who underwent G-POEM for refractory gastroparesis from August 2016 to October 2017. This study included 11 males and 5 females; in addition, 13 patients had postsurgical gastroparesis, and 3 patients had diabetes. The patients included had severe and refractory gastroparesis, as indicated by a Gastroparesis Cardinal Symptom Index (GCSI) score ≥20, and evidence of a delay on gastric emptying scintigraphy (GES). The primary outcome parameter was an assessment of the long-term clinical efficacy of the procedure. The secondary outcome parameter was the detection of possible predictive factors for success and the determination of cut-off values for such predictors. Results Technical success was achieved in 100% of the patients, with a mean procedure time of 45.25±12.96 min. The long-term clinical response was assessed in all patients during a median follow-up of 14.5 months. Clinical success was achieved in 13 (81.25%) patients. There was a significant reduction in the GCSI scores and GES values after the procedure compared to the baseline values, with P values of <0.0001 and 0.012, respectively. Univariate regression analysis showed that the GCSI and GES had significant associations with the future clinical outcomes of the patients, but this finding was not confirmed in multivariate analysis. A GCSI cut-off score of ≤30 had a high sensitivity and a negative predictive value (NPV) of 100% for predicting a successful procedure. GES (half emptying time ≤221.6 min and 2-hour retention ≤78.6%) had a high specificity and a positive predictive value (PPV) of 100%. Conclusions G-POEM is a safe and effective treatment option with a long-term efficacy of 81.6%. GCSI and GES could serve as good predictive measures.

Gastric peroral endoscopic pyloromyotomy versus gastric electrical stimulation in the treatment of refractory gastroparesis: a propensity score-matched analysis of long term outcomes

“…Our 1-year response rate in patients receiving G-POEM treatment was 86.5 %. This finding aligns with two recent studies that reported a high 1-year response rate of 81 % -85 % after G-POEM treatment [9,10].…”

“…First, delayed gastric emptying caused by pyloric sphincter dysfunction (or pylorospasm) is potentially a significant contributor to the symptoms of gastroparesis [24,25]. The hypothesis that pylorus-directed therapy is superior to GES is mainly based on impressive results of laparoscopic and endoscopic pyloroplasty [9,10,14,19,26]. G-POEM is an endoscopic pylorus-directed therapy that is less invasive than laparoscopic pyloroplasty; G-POEM possibly also offers similar long-term relief for patients with refractory gastroparesis compared with surgery [27].…”

Endoscopic foregut surgery and interventions: The future is now. The state-of-the-art and my personal journey

“…In patients with benign GOO, namely gastroparesis contributed by a tight pylorus, gastric POEM (G-POEM) of the pylorus is now emerging as a treatment option. After the initial case report of G-POEM in a patient with gastroparesis[150], there have been a number of small series[151-160] showing safety, feasibility, and good clinical outcomes with approximately 70% patients showing improvement in their quality of life scores at 1 year[152]. One non-randomized study compared laparoscopic pyloroplasty (LP) vs G-POEM and found that patients who underwent LP had a longer average length of stay (4.6 d vs 1.4 d, P = 0.003), operative time (99.3 min vs 33.9 min, P < 0.001), and estimated blood loss (12.9 mL vs 0.4 mL, P < 0.001).…”

Gastric peroral endoscopic pyloromyotomy for decompensated gastroparesis: comprehensive motility analysis in relation to treatment outcomes

“…Gastric peroral endoscopic pyloromyotomy (G-POEM) was introduced in 2013 as an alternative therapeutic modality for GP patients with refractory symptoms 3 . In recent years, several groups have reported promising data on G-POEM in terms of safety and efficacy outcomes in the short- and midterm 4 5 6 7 8 9 10 11 12 13 . In a recent pooled analysis of 10 studies and 292 patients with a mean follow-up of 7.8 months, a significant symptomatic improvement was achieved after 84 % of G-POEM procedures 14 .…”