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Gastroparesis is a potentially debilitating gastric motility disorder with limited treatment options. Symptoms can result in hospitalization and poor nutrition requiring nutritional support. Treatment options with highest efficacy include gastric peroral endoscopic myotomy (GPOEM) and surgical pyloromyotomy. Limited information is available comparing these two techniques.
We aim to compare the efficacy and safety of GPOEM versus surgical pyloromyotomy in patients with gastroparesis.
A retrospective analysis of patients who underwent GPOEM or surgical pyloromyotomy for refractory gastroparesis from 4 centers across the US and Latin America were included. Electronic medical records were used to collect data on patient demographics, relevant imaging studies and laboratory values, technical success, clinical success, gastroparesis cardinal symptom index (GCSI), procedure time, pre- and post-op gastric emptying times, adverse events, and hospital length of stay (LOS).
A total of 102 patients were included (mean age 47; 32.4% male): GPOEM n=39, surgical pyloromyotomy n=63. Age and pre-op BMI were not statistically different between the two groups (p=0.232, p=0.059, respectively). Patient demographics are outlined in Tables 1 and 2. Technical success rate was 100% in both groups. Clinical success rate was 92.3% in the GPOEM group and 82.5% in the surgery group (p=0.164). The GPOEM group had a significantly higher post-op GSCI score reduction by 1.3 units (p<0.00001), post-op retention reduction at 2 hours by 18% (p<0.00001), post-op retention reduction at 4 hours by 25% (p<0.00001) and a lower procedure time by 20 minutes (p<0.00001) as compared to surgery. GPOEM also had a lower hospital LOS by 2.8 days (p<0.00001). Adverse event rates were significantly lower in the GPOEM group (13%) compared to the surgery group (33.3% ; p=0.021). Mean blood loss in the GPOEM group was only 3.6 ml as compared to 866 ml in the surgery group.
GPOEM may be a less invasive, safer, and more efficacious procedural treatment for refractory gastroparesis as compared to surgical pyloromyotomy.