Post written by Qiang Cai, MD, PhD, from the Emory University School of Medicine, Division of Digestive Diseases, Atlanta, Georgia, USA.
The focus of our study was to compare the short-term outcomes of double myotomy versus single myotomy at peroral endoscopic pyloromytomy in the treatment of gastroparesis.
Peroral endoscopic pyloromytomy (POP or GPOEM) is a relatively new therapeutic modality for gastroparesis. Routinely, only a single myotomy is performed at GPOEM. The efficacy is about 70% to 80%. Among the responders, some may recur after a certain time and a second GPOEM with another myotomy may be needed. The question is whether we should perform 2 myotomies (double) at the index GPOEM to prolong the clinical efficacy and reduce the recurrence? Therefore, it is important to conduct a study to compare the outcome of double (2) myotomy versus single (1) myotomy at GPOEM.
We studied 90 patients who underwent GPOEM (55 single and 35 double pyloromyotomy). Mean age was 47 ± 14 years old, mean duration of symptoms was 5.3 ± 4.4 years. Average GCSI was 3.8 before GPOEM, and the average GCSI 6 months after procedure was 1.8. 37 of 55 (67%) patients underwent single pyloromyotomy achieved clinical response compared to 30 of 35 (86%) patients receiving double pyloromyotomy. There were no significant differences between procedure time, post-operative pain, or length of hospital stay among the 2 groups. There was no difference in adverse events in the 2 pyloromyotomy groups.
The limitation of the study is that it was not a randomized study and also it was short-term (6 months) outcomes. We also performed redo GPOEM. Our preliminary results showed promising outcomes for redo GPOEM (Journal of GHR 2020; 9(4): 1-2). At this time, we need more studies to find which is better: double pyloromyotomy at index GPOEM or redo GPOEM when gastropareis recurs.
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