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

Abstract

Background and study aims There are no reliable data to predict which patients with gastroparesis (GP) would benefit the most from gastric peroral endoscopic pyloromyotomy (G-POEM). The aim of the present study was to assess whether antro-duodenal motility patterns and pyloric distensibility can predict the outcome of G-POEM in patients with decompensated GP. Patients and methods In an open-label study, patients with GP and refractory symptoms were eligible for treatment with G-POEM if treatment attempts according to a standardized stepwise protocol had failed. Baseline assessment included Gastroparesis Cardinal Symptom Index (GCSI), C13-octanoic gastric emptying breath test and high-resolution antro-duodenal manometry. Pyloric distensibility using EndoFlip measurements was assessed at baseline and 3 months after the procedure. Explorative analyses were performed on potential predictors of response using logistic regression analyses. Results Twenty-four patients with decompensated GP underwent G-POEM. At baseline, 78.3 % and 61.9 % of patients showed antral hypomotility and neuropathic motor patterns, respectively. The technical success rate was 100 % (24/24). Mean GCSI improved significantly at 3, 6, and 12 months after G-POEM (P = 0.01). Median distensibility index (DI) improved significantly as compared with baseline (7.5 [6.9;11.7] vs. 5.3[3.1;8.1], P = 0.004). A significant correlation was found between clinical response at 6 months and pyloric DI improvement (P = 0.003). No potential predictors of clinical response after G-POEM could be identified in an explorative analysis. Conclusions G-POEM improved pyloric distensibility patterns in patients with decompensated GP. Clinical response at 6 months after G-POEM was associated with pyloric distensibility improvement. However, no potential predictors of response could be identified from either antro-duodenal motility patterns or pyloric distensibility.

Devices for esophageal function testing

“…Additional applications include assessment of pylorus distensibility before or during gastric peroral endoscopic myotomy (POEM) or surgical pyloromyotomy, estimation of the size of the stoma after gastric band placement, intraoperative assessment for fundoplication tightness and lower esophageal sphincter myotomy adequacy, and as an adjunct to a bougie for measuring the size of the gastric sleeve during a sleeve gastrectomy. [7][8][9] Main components. The FLIP system consists of a 240cm-long, 3-mm-diameter catheter with a highly compliant balloon at the distal end that conforms to the esophageal lumen (Table 1).…”

Systematic review with meta‐analysis: one‐year outcomes of gastric peroral endoscopic myotomy for refractory gastroparesis

“…Therefore, we included 10 studies comprising 482 patients in our meta-analysis. [21][22][23]26,[28][29][30][31][32][33] Of these, three [21][22][23] with 151 patients were prospective and seven 26,[28][29][30][31][32][33] with 331 patients were retrospective. Eight studies with 428 patients reported data on our primary outcome of interest.…”

“…More recent studies with longer follow-up have evaluated the efficacy of G-POEM. [21][22][23] In this systematic review and meta-analysis, we have evaluated the mid-term efficacy of G-POEM by only including studies with a minimum of 1 year of follow-up.…”

Gastric per-oral endoscopic myotomy: Indications, technique, results and comparison with surgical approach

“…Recently, Conchillo et al [ 18 ] published a very interesting study with 24 patients (100% technical success rate) to investigate the role of antroduodenal motility pattern and EndoFLIP in predicting the outcome after GPOEM: Clinical response was not correlated with motility pattern, whereas was associated with the pyloric distensibility improvement. However, there are no yet parameters that can surely predict the clinical response after GPOEM[ 18 , 19 ].…”