One-year results of gastric peroral endoscopic myotomy for refractory gastroparesis: a French multicenter study

Abstract

Introduction Data on the long-term outcomes of gastric per-oral endoscopic myotomy (G-POEM) for refractory gastroparesis are lacking. We report the results of a large multicentre long-term follow-up study of G-POEM for refractory gastroparesis. Materials and methods This was a retrospective, multicentre study of all G-POEM operations performed in seven expert French centres for refractory gastroparesis with at least 1 year of follow-up. The primary endpoint was the 1-year clinical success rate, defined as an at least one-point improvement in the Gastroparesis Cardinal Symptom Index (GCSI). Results Seventy-six patients were included (Women: 60.5%; Age: 56 years). The median symptom duration was 48 months. The median gastric retention at 4 h (H4) before G-POEM was 45% [IQR: 29; 67]. The median GCSI before G-POEM was 3.6 [IQR: 2.8; 4]. Clinical success was achieved in 71.4% of the patients at 1 year, with a median rate of reduction in the GCSI score of 41%. In logistic regression analysis, only a high preoperative GCSI satiety subscale was predictive of clinical success (OR = 3.41 (CI95% 1.01–11.54), p = 0.048), while a high rate of gastric retention at H4 was significantly associated with clinical failure (OR = 0.97 (CI95% 0.95–1.00), p = 0.032). Conclusions The results confirm the efficacy of G-POEM for the treatment of refractory gastroparesis, as evidenced by a 71.4% clinical success rate at 1 year. G-POEM is promising, prospective sham-controlled trials are urgently needed to confirm its efficacy and identify the patient populations who will benefit most from this procedure.

Pyloric dilation with the esophageal functional lumen imaging probe in gastroparesis improves gastric emptying, pyloric distensibility, and symptoms

“…8 Because the pylorus is amenable to endoscopic myotomy, the recent literature has been dominated by studies assessing the therapeutic effect of endoscopic pyloromyotomy (gastric peroral endoscopic myotomy [G-POEM]), whereas other endoscopic treatment modalities such as dilation outside a postoperative setting have only scarcely been evaluated. [9][10][11] Our group recently published results of achalasia treatment with the esophageal FLIP (Eso-FLIP; Crospon Ltd, Galway, Ireland). 12 EsoFLIP is based on FLIP hardware, allowing real-time and dynamic visualization of the pyloric sphincter and intratherapeutic monitoring of diameter, CSA, and intraballoon pressure.…”

Third-Space Endoscopy: Recent Updates

“…Per-oral endoscopic pyloromyotomy or gastric POEM (G-POEM) is a recent addition to the endoscopic armamentarium for the management of refractory gastroparesis. [44][45][46][47] Overall, the pooled clinical response rate of G-POEM in the initial studies was 84% (95% CI: 77-89%). 48 However, the limitations of the initial studies include small sample size, retrospective design, and short follow-up periods.…”

G-POEM – Gastrale perorale endoskopische Myotomie als Therapieoption bei chronischer Magenentleerungsstörung

“…Die Sicherheit und Machbarkeit konnten bisher in vielen Studien belegt werden [18]. Auch zeigte sich in einer jüngsten Publikation ein anhaltender, klinischer Effekt bei 65 % der Patienten nach einem Jahr [5].…”

“…A relatively high response could be documented in previous publications [4]. The long-term successes are still being discussed controversially [5]. After the initial euphoria, the problem of patient selection comes to the fore.…”

“…In den bisherigen Publikationen konnte ein relativ hohes Ansprechen dokumentiert werden [4]. Noch kontrovers werden die Langzeiterfolge diskutiert [5]. Nach anfänglicher Euphorie tritt immer mehr das Problem der Patientenselektion in den Vordergrund.…”