Post written by Andrew Canakis, DO, from the Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland, USA.

Refractory gastroparesis is a chronic debilitating condition that results in decreased quality of life, weight loss/malnutrition, and increased healthcare costs. Medical options with prokinetic agents are often limited, and intrapyloric botulinum toxin injection has failed to show any long-term benefit.

Targeting pyloric dysfunction with a surgical pyloromyotomy has yielded positive results. However, widespread use of this technique is limited by its invasiveness, postoperative adverse events (leaks, suture line bleeding, and/or infection), and morbidity. Plus, many surgeons may be unwilling to perform and manage these patients in the long-term setting.

In the context of limited therapeutic modalities, gastric peroral endoscopic myotomy (G-POEM) has emerged as a minimally invasive method to treat pyloric dysfunction. Pylorospasms are thought to be a major contributor of symptoms. G-POEM has the potential to provide the surgical benefits of pyloromyotomy without the associated risks of surgery. Since its introduction in 2013, G-POEM has shown clinical promise.

Yet, long-term benefits are still uncertain. As such, our study aimed to explore the long-term durability of G-POEM in cases of refractory gastroparesis.

Exploring the long-term benefits of G-POEM is extremely important, especially because these patients are often left with limited treatment options. Despite the rapid implementation of this technique, only a handful of studies have explored G-POEM’s long-term success. Understanding these outcomes can help clinicians select patients for this procedure.

Our analysis included 7 studies with 560 patients over a mean follow-up of 38.4 months. At 36 months, the pooled rate of clinical success was 75%. The mean values of Gastroparesis Cardinal Symptom Index significantly decreased 36 months after the procedure (standardized mean difference, 3.3).

The promising results of this study show that G-POEM is indeed a viable clinical option for patients with refractory gastroparesis. Moving forward, identifying patient selection factors that may predict long-term G-POEM success is needed.

Forest plot of clinical success. CI, Confidence interval.

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