Gastric peroral endoscopic myotomy for the treatment of refractory gastroparesis

Post written by Mohammad Al-Haddad, MD, from the Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA.

Dr. Mohammad Al-Haddad, portrait, University

The study focused on prospectively assessing the safety and efficacy of gastric peroral endoscopic myotomy in improving symptoms, quality of life, and healthcare resource utilization in a cohort of gastroparesis patient that had failed medical therapy. Our study is supported by a meticulous and elaborate follow-up protocol including objective testing (like gastric emptying scans and EndoFlip) as well subjective but validated tools for assessing gastroparesis symptoms and quality of life like PAGI-SYM and SF36.

Gastric peroral endoscopic myotomy has been conducted for over 7 years, but the data supporting its universal adoption for patients with refractory gastroparesis is lacking. Most importantly, identifying particular patient phenotypes who would benefit from this intervention the most would be of interest. Additionally, studying the longevity of clinical response post G-POEM sheds further light on the overall value this intervention.

Our study supports the safety and intermediate term clinical efficacy of G-POEM in 48 patients with refractory gastroparesis. The technical success rate was 100%. We report clinical response (defined as an improvement of ≥1 point on GCSI) in 70%, 58%, and 50% of patients at 1-month, 6-month, and 12-month follow-up. A similar 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 (10.0%) compared to baseline (35.8%, P < 0.001). Prior clinical response to botox injection of the pylorus appears to be a reliable predictor to clinical response after G-POEM. We report a significant reduction in the number of emergency room visits and days spent in the hospital up to 12 months post G-POEM.

Although G-POEM may not be the suitable choice for every patient with gastroparesis, it should be considered in patients with refractory symptoms, significantly compromised quality of life, and recurrent admissions to the hospital.


Read the full article online.

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