Gastric peroral endoscopic myotomy in refractory gastroparesis: long-term outcomes and predictive score to improve patient selection

Third-space endoscopy: the final frontier

“…A few studies have recently reported long-term outcomes of G-POEM in patients with refractory gastroparesis. Two separate small prospective studies from the USA ( n = 48) and Europe ( n = 46) reported clinical success rates of 45% and 65% at 36-month follow-up, respectively [ 61 , 62 ]. Hernández Mondragón et al [ 63 ] reported G-POEM outcomes after 4-year follow-up in a study of 374 patients demonstrating a clinical success rate of 77% after the 48-month evaluation, although only 102 patients completed the follow-up.…”

Gastric peroral endoscopic myotomy for gastroparesis: making sense of the pros

“…It is one that may benefit somedbut whom? To answer that, Labonde et al, 4 whose study appears in this issue of Gastrointestinal Endoscopy, tried to devise a scoring system predictive of success in selecting patients for G-POEM. In their prospectively collected, retrospective multicenter study looking at the long-term outcomes of G-POEM as a treatment option for refractory gastroparesis (a clear definition of which was not stated), 46 patients were followed up for at least 3 years.…”

“…Previous studies have identified several distinct patient characteristics that could independently predict success after G-POEM, the most recent being gastric retention >20% at 4 hours and high preoperative GCSI. 5 Using univariate analysis, Labonde et al 4 found that patients with high preoperative bloating subscale scores achieved higher clinical success, whereas patients with higher preoperative nausea subscale scores experienced higher failure. With this information and using a receiver operative curve, the authors created a "G-POEM predictive score" with a threshold score of 2 (nausea subscale <2 [1 point], satiety subscale >4 [1 point], bloating subscale >3.5 [1 point], H4% (4-hour percentage retention on gastric scintigraphy) >50% (1 point)] as predictors of clinical response at 3 years in comparison with patients with scores of <2 (80% vs 18%; P Z .0004).…”

“…Small effect sizes are often less compelling than large ones and require larger sample sizes to detect associations between interventions and outcomes. Whereas the efforts of Labonde et al 4 to develop a predictive scoring tool is applauded, the relatively small sample size (n Z 46) and unclear effect size of G-POEM on gastroparesis symptoms implies that their study may be inherently underpowered and subject to type II errors. The authors, however, rightfully highlight the need for larger studies to assess the validity of their conclusions.…”

“…Labonde et al 4 highlight the importance of long-term follow-up to better understand the clinical success of G-POEM. In their study, the 1-year clinical success rate was 69%, similar to that reported by Abdelfatah et al 6 Furthermore, 21.7% of patients (n Z 10/46) initially did not have a clinical response to G-POEM at 12 and 24 months but had a clinical response to therapy at 36 months.…”