Laparoscopic pyloroplasty versus endoscopic per-oral pyloromyotomy for the treatment of gastroparesis

Abstract

Per-oral endoscopic pyloromyotomy (POP) is safe and effective for the treatment of medical refractory gastroparesis. POP has less perioperative morbidity compared to LP with comparative functional outcomes.

Endoscopic Intramural Surgery Part II: Muscular Division

“…LP and POP both showed similar results with significant improvements in symptom scores and objective gastric emptying. 38 Our group has also reported on the largest single center experience of 100 consecutive cases of POP between January 2016 and October 2017. Patients were evaluated using the Gastroparesis Cardinal Symptom Index (GCSI), followed by a 4-hour solid-phase scintigraphic gastric emptying studies (GES) prior to surgery and later 90 days in the postoperative follow-up.…”

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

“…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.…”

“…A summary of the characteristics of the included studies is shown in ▶ Table 1. Landrenau et al [1] were the only authors who compared G-POEM to laparoscopic pyloroplasty; thus, we did not analyze the laparoscopic data. 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).…”

“…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.…”

“…Hibbard et al and Toro et al described a similar retrospective study of their experience with this procedure in 28 and 50 patients, respectively, reporting symptomatic improvement in 83 % and 82 %, respectively [36,39]. Therefore, few complications are described, such as leaks, wound infections and hospital readmission, to control refractory symptoms or for reoperation [1,11].…”