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Gastric peroral endoscopic pyloromyotomy for refractory gastroparesis: a systematic review of early outcomes with pooled analysis

Published:December 03, 2019DOI:https://doi.org/10.1016/j.gie.2019.11.039

      Background and Aims

      Gastroparesis (GP) is a chronic debilitating condition. Prior pyloric-targeted procedures are either invasive or have questionable efficacy. Gastric peroral pyloromyotomy (G-POEM) has been proposed as a minimally invasive approach. We performed a pooled analysis to evaluate the efficacy and safety of G-POEM for GP.

      Methods

      Electronic databases (Medline, Scopus, EMBASE) were searched up to January 2019. Studies including patients who underwent G-POEM for GP were eligible. Procedural, clinical, and safety outcomes were assessed by pooling data with a random- or fixed-effect model according to the degree of heterogeneity to obtain a proportion with a 95% confidence interval.

      Results

      Ten studies were eligible for inclusion (292 patients), and 2 of the 10 studies were prospective. Seven studies were performed in the United States, 2 in France, and 1 in China. Endoscopic pyloromyotomy was feasible in all patients. Significant symptomatic improvement was achieved after 83.9% of procedures (mean follow-up, 7.8 ± 5.5 months). When comparing the mean values of pre- and postprocedural scintigraphic evolution, there was a significant decrease of the residual percentage at 2 and 4 hours. The overall adverse events rate was 6.8%.

      Conclusions

      G-POEM appears to be a promising approach for GP in terms of safety and efficacy outcomes in the short term.

      Abbreviations:

      GCSI (Gastroparesis Cardinal Symptom Index), GP (gastroparesis), G-POEM (gastric peroral endoscopic pyloromyotomy), POEM (peroral endoscopic myotomy)
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      References

        • Parkman H.P.
        • Hasler W.L.
        • Fisher R.S.
        American Gastroenterological Association technical review on the diagnosis and treatment of gastroparesis.
        Gastroenterology. 2004; 127: 1592-1622
        • Wang Y.R.
        • Fisher R.S.
        • Parkman H.P.
        Gastroparesis-related hospitalizations in the United States: trends, characteristics, and outcomes, 1995-2004.
        Am J Gastroenterol. 2008; 103: 313-322
        • Jones K.L.
        • Russo A.
        • Stevens J.E.
        • et al.
        Predictors of delayed gastric emptying in diabetes.
        Diabetes Care. 2001; 24: 1264-1269
        • Oh J.H.
        • Pasricha P.J.
        Recent advances in the pathophysiology and treatment of gastroparesis.
        J Neurogastroenterol Motil. 2013; 19: 18-24
        • Acosta A.
        • Camilleri M.
        Prokinetics in gastroparesis.
        Gastroenterol Clin North Am. 2015; 44: 97-111
        • Mearin F.
        • Camilleri M.
        • Malagelada J.R.
        Pyloric dysfunction in diabetics with recurrent nausea and vomiting.
        Gastroenterology. 1986; 90: 1919-1925
        • Gourcerol G.
        • Tissier F.
        • Melchior C.
        • et al.
        Impaired fasting pyloric compliance in gastroparesis and the therapeutic response to pyloric dilatation.
        Aliment Pharmacol Ther. 2015; 41: 360-367
        • Malik Z.
        • Sankineni A.
        • Parkman H.P.
        Assessing pyloric sphincter pathophysiology using EndoFLIP in patients with gastroparesis.
        Neurogastroenterol Motil. 2015; 27: 524-531
        • Toro J.P.
        • Lytle N.W.
        • Patel A.D.
        • et al.
        Efficacy of laparoscopic pyloroplasty for the treatment of gastroparesis.
        J Am Coll Surg. 2014; 218: 652-660
        • Clarke J.O.
        • Snape Jr., W.J.
        Pyloric sphincter therapy: botulinum toxin, stents, and pyloromyotomy.
        Gastroenterol Clin North Am. 2015; 44: 127-136
        • Sarosiek I.
        • Davis B.
        • Eichler E.
        • et al.
        Surgical approaches to treatment of gastroparesis: gastric electrical stimulation, pyloroplasty, total gastrectomy and enteral feeding tubes.
        Gastroenterol Clin North Am. 2015; 44: 151-167
        • Khashab M.A.
        • Stein E.
        • Clarke J.O.
        • et al.
        Gastric peroral endoscopic myotomy for refractory gastroparesis: first human endoscopic pyloromyotomy (with video).
        Gastrointest Endosc. 2013; 78: 764-768
        • Inoue H.
        • Minami H.
        • Kobayashi Y.
        • et al.
        Peroral endoscopic myotomy (POEM) for esophageal achalasia.
        Endoscopy. 2010; 42: 265-271
        • Moher D.
        • Shamseer L.
        • Clarke M.
        • et al.
        Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation.
        BMJ. 2015; 350 (g7647)
        • Barbieri L.A.
        • Hassan C.
        • Rosati R.
        • et al.
        Systematic review and meta-analysis: efficacy and safety of POEM for achalasia.
        United Eur Gastroenterol J. 2015; 3: 325-334
        • Ngamruengphong S.
        • Inoue H.
        • Ujiki M.B.
        • et al.
        Efficacy and safety of peroral endoscopic myotomy for treatment of achalasia after failed heller myotomy.
        Clin Gstroenterol Hepatol. 2017; 15: 1531-1537
        • Tyberg A.
        • Sharaiha R.Z.
        • Familiari P.
        • et al.
        Peroral endoscopic myotomy as salvation technique post-Heller: international experience.
        Dig Endosc. 2018; 30: 52-56
        • Shlomovitz E.
        • Pescarus R.
        • Cassera M.A.
        • et al.
        Early human experience with per-oral endoscopic pyloromyotomy (POP).
        Surg Endosc. 2015; 29: 543
        • Gonzalez J.M.
        • Benezech A.
        • Vitton V.
        • et al.
        G-POEM with antro-pyloromyotomy for the treatment of refractory gastroparesis: mid-term follow-up and focus on outcome predictive factors.
        Aliment Pharmacol Ther. 2017; 46: 364-370
        • Xue H.B.
        • Fan H.Z.
        • Meng X.M.
        • et al.
        Fluoroscopy-guided gastric peroral endoscopic pyloromyotomy (G-POEM): a more reliable and efficient method for treatment of refractory gastroparesis.
        Surg Endosc. 2017; 31: 4617
        • Kahaleh M.
        • Gonzalez J.M.
        • Xu M.
        • et al.
        Gastric peroral endoscopic myotomy for the treatment of refractory gastroparesis: a multicenter international experience.
        Endoscopy. 2018; 50: 1053-1058
        • Malik Z.
        • Kataria R.
        • Modayil R.
        • et al.
        Gastric per oral endoscopic myotomy (G-POEM) for the treatment of refractory gastroparesis: early experience.
        Dig Dis Sci. 2018; 63: 2405
        • Xu J.
        • Chen T.
        • Elkholy S.
        • et al.
        Gastric peroral endoscopic myotomy (G-POEM) as a treatment for refractory gastroparesis: long-term outcomes.
        Can J Gastroenterol Hepatol. 2018; (6409698)
        • Jacques J.
        • Pagnon L.
        • Hure F.
        • et al.
        Peroral endoscopic pyloromyotomy is efficacious and safe for refractory gastroparesis: prospective trial with assessment of pyloric function.
        Endoscopy. 2019; 51: 40-49
        • Mekaroonkamol P.
        • Dacha S.
        • Wang L.
        • et al.
        Gastric peroral endoscopic pyloromyotomy reduces symptoms, increases quality of life, and reduces health care use for patients with gastroparesis.
        Clin Gastroenterol Hepatol. 2019; 17: 82-89
        • Khashab M.A.
        • Ngamruengphong S.
        • Carr-Locke D.
        • et al.
        Gastric per-oral endoscopic myotomy for refractory gastroparesis: results from the first multicenter study on endoscopic pyloromyotomy (with video).
        Gastrointest Endosc. 2017; 85: 123-128
        • Rodriguez J.
        • Strong A.
        • Haskins I.
        • et al.
        Per-oral pyloromyotomy (POP) for medically refractory gastroparesis: short term results from the first 100 patients at a high volume center.
        Ann Surg. 2018; 268: 421-430
        • Khashab M.A.
        • Besharati S.
        • Ngamruengphong S.
        • et al.
        Refractory gastroparesis can be successfully managed with endoscopic transpyloric stent placement and fixation (with video).
        Gastrointest Endosc. 2015; 82: 1106-1109
        • Friedenberg F.K.
        • Palit A.
        • Parkman H.P.
        • et al.
        Botulinum toxin A for the treatment of delayed gastric emptying.
        Am J Gastroenterol. 2008; 103: 416-423
        • Mekaroonkamol P.
        • Li L.
        • Cai Q.
        The role of pyloric manometry in gastric per-oral endoscopic pyloromyotomy (G-POEM): response to Jacques et al.
        Neurogastroenterol Motil. 2017; 29: 1
        • Abell T.L.
        • Camilleri M.
        • Donohoe K.
        • et al.
        Consensus recommendations for gastric emptying scintigraphy: a joint report of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine.
        Am J Gastroenterol. 2008; 103: 753-763
        • Gonlachanvit S.
        • Maurer A.
        • Fisher R.
        • et al.
        Regional gastric emptying abnormalities in functional dyspepsia and gastrooesophageal reflux disease.
        Neurogastroenterol Motil. 2006; 18: 894-904
        • Maurer A.H.
        • Parkman H.P.
        Update on gastrointestinal scintigraphy.
        Semin Nucl Med. 2006; 36: 110-118

      Reference

        • Rodriguez J.
        • Strong A.T.
        • Haskins I.N.
        • et al.
        Per-oral pyloromyotomy (POP) for medically refractory gastroparesis: short term results from the first 100 patients at a high volume center.
        Ann Surg. 2018; 268: 421-430

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