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

Abstract

Background and aim Gastric peroral endoscopic pyloromyotomy (G-POEM) is a new therapeutic option for refractory gastroparesis (GP). A systematic review and meta-analysis was conducted to assess the effectiveness of G-POEM in refractory GP. For the quality of evidence, we used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Methods We performed a literature search using MEDLINE, Embase, Cochrane library, LILACS and the Science citation index for studies related to G-POEM from the inception of its technique through January 2019. We selected studies that analyzed the gastroparesis cardinal symptom index (GCSI) and 4-hour solid-phase gastric emptying scintigraphy (GES) before and after the procedure to verify the efficacy of G-POEM, the main outcome measured. An analysis was performed using RevMan 5.3. Results Ten studies comprising 281 patients were included in this systematic review. The pooled mean difference in GCSI following the procedure was 1.76 (95 % CI: [1.43, 2.08], I2 = 72 %). We also performed GCSI subgroup analysis by follow-up duration that showed a pooled mean difference of 1.84 (95 % CI: [1.57, 2.12], I2 = 71 %). The pooled mean difference in GES after the procedure was 26.28 (95 % CI: [19.74, 32.83], I2 = 87 %), corresponding to a significant drop in percentage values of the gastric retention 4-hour scintigraphy. Conclusion This meta-analysis demonstrates that G-POEM is effective and shows promising outcomes in the clinical response and gastric emptying scintigraphy for gastroparesis. Therefore, it should be considered in the management of refractory gastroparesis.

Direct optogenetic stimulation of smooth muscle cells to control gastric contractility

“…Unfortunately, many have proven to be largely non-effective in achieving this goal 13 . Surgical options like transpyloric stents, pylorotomy or gastrectomy may ameliorate some symptoms, but inevitably curtail the stomach's roles as a digestive organ and reservoir with the risk of severe secondary complications 14 - 17 .…”

Short-term outcomes of different modalities of pyloromyotomy versus gastric electrical stimulation in the treatment of gastroparesis

“…One meta-analysis demonstrated that the pooled mean differences in GCSI scores and the 4-hour solid-phase gastric emptying scintigraphy following single POP were significant at 1.76 and 26.28, respectively, as well as showing POP as having a 71% clinical success rate. [ 18 ] Another recent meta-analysis [ 17 ] revealed that pooled clinical success rates based upon GCSI scores and the 4-hour gastric emptying scintigraphy after single POP were not significant at 75.8% and 85.1%, respectively, when compared to surgical pyloromyotomy. In our study we further prove that double POP may offer better clinical success results than both single POP and LP, with similar recurrence and complication rates.…”

“…Furthermore, double POP is performed with 2 circular pyloromyotomies in 1 session when compared to single POP. Recently, 1 systemic review reported improved outcomes in clinical response and gastric emptying scintigraphy regarding POP alone in the treatment of gastroparesis, [ 18 ] thus the application of this datum in clinical practice may be of limited value. Therefore, the aim of this systemic review and meta-analysis was to compare the short-term outcomes surrounding the efficacy, as well as the complication rate between different modalities of pyloromyotomy and GES, in the treatment of gastroparesis.…”

Endoscopic Management of Gastroparesis

“…The analysis demonstrated an overall 100% technical success rate and a 71% clinical success rate. 59 Predictive factors of poor response to treatment include female gender and diabetic gastroparesis. Favorable results are seen in patients with documented EndoFLIP measurements (distensibility, length, cross-sectional area, and pressure) showing pyloric pathology, idiopathic/postsurgical gastroparesis, and those who responded to pyloric stenting/dilation or botox injection.…”