Gastric peroral endoscopic myotomy for the treatment of refractory gastroparesis: a prospective single-center experience with mid-term follow-up (with video)

Published:December 25, 2020DOI:https://doi.org/10.1016/j.gie.2020.12.030

      Background and Aims

      Gastroparesis (GP) is a multifactorial disease associated with a large burden on the health care systems. Pyloric-directed therapies including gastric peroral endoscopic myotomy (G-POEM) can be effective in improving patient quality of life and symptom severity. We report on the safety and efficacy of G-POEM and its impact on the quality of life of patients managed at a large referral center.

      Methods

      Consecutive patients with confirmed GP referred for G-POEM due to failure of medical therapy were included. All patients were assessed at baseline and then at 1, 3, 6, and 12 and 24 months after G-POEM using validated symptom and quality of life instruments, including the Gastroparesis Cardinal Symptom Index (GCSI), Patient Assessment of Gastrointestinal Disorders Symptom Severity Index (PAGI-SYM), and 36-Item Short Form Survey (SF-36). Patients were evaluated before and 6 months after the procedure with EGD, 4-hour scintigraphy, and pyloric EndoFLIP. Technical success was defined as the ability to perform full-thickness pyloromyotomy. Clinical response was defined as an improvement of ≥1 point on GCSI.

      Results

      Fifty-two patients (median age, 48 years; range, 25-80 years, 88% female) underwent G-POEM between February 2018 and September 2020 for the following phenotypes: vomiting-predominant (n=30), dyspepsia-predominant (n=16), and regurgitation-predominant (n=6) GP. The technical success rate was 100%. Adverse events were noted in 3 of 52 patients (5.77%), and were all managed successfully endoscopically. Clinical response was achieved in 68%, 58%, and 48% of patients at 1-month, 6-month, and 12-month follow-up (P < .001, P < .001, and P < .01, respectively). When classified by the cause of GP, the clinical response rates were diabetic GP 64% (11 of 17), postsurgical GP 67% (6 of 9), and idiopathic GP 72% (13 of 18). A statistically significant improvement in PAGI-SYM scores was observed at 1, 3, 6, 12, and 24 months, in addition to significant improvement in several domains of SF-36. Mean 4-hour gastric emptying was reduced 6 months after G-POEM (10.2%) compared with baseline (36.5%, P < .001). We report a significant reduction in the number of emergency department visits and days spent in the hospital up to 24 months after G-POEM.

      Conclusions

      G-POEM appears to be a safe and feasible treatment alternative for refractory GP with significant short-term and mid-term improvements in overall symptoms, quality of life scores, and health care utilization.

      Graphical abstract

      Abbreviations:

      BL (bloating), GCSI (Gastroparesis Cardinal Symptom Index), GES (gastric emptying scan), FLIP (functional luminal imaging probe), GP (gastroparesis), G-POEM (gastric peroral endoscopic myotomy), HR (heartburn/regurgitation), LA (lower abdominal), NV (nausea and vomiting), PAGI-SYM (Patient Assessment of Gastrointestinal Disorders Symptom Severity Index), PDI (Pyloric Distensibility Index), PS (postprandial fullness/early satiety), QOL (quality of life), SF-36 (36-Item Short Form Survey), UA (upper abdominal pain)
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      Linked Article

      • Gastric POEM for gastroparesis: Panacea, placebo, or pathway to the future?
        Gastrointestinal EndoscopyVol. 94Issue 1
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          Gastroparesis (GP) is a syndrome defined by delayed gastric emptying in the absence of mechanical obstruction.1 Typical symptoms include abdominal pain, nausea, vomiting, early satiety, bloating, and/or weight loss.2 It is 1 of the 2 most common sensorimotor disorders of the stomach, the other being functional dyspepsia.3 It is estimated that approximately 5 million adults in the United States have GP symptoms.4 The causes of GP are diverse; there are more than 50 recognized causes, although diabetes accounts for the majority of known cases (25%).
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