Post written by Harsimran Kalsi, MD, from the Department of Internal Medicine, University of Central Florida/HCA Florida North Florida Hospital, Gainesville, Florida, Saurabh Chandan, MD, from Advanced Endoscopy, Houston Methodist West Hospital, Houston, Texas, and Dennis Yang, MD, from the Division of Gastroenterology and Hepatology, Advent Health, Orlando, Florida, USA. 

The primary focus of our study was to evaluate whether pyloric impedance planimetry measurements, specifically cross-sectional area (CSA) and distensibility index (DI) obtained using the endoscopic functional lumen imaging probe (EndoFLIP), are associated with clinical response following gastric peroral endoscopic myotomy (G-POEM) in patients with refractory gastroparesis.

G-POEM has emerged as an important therapeutic option for patients who remain symptomatic despite medical therapy. However, identifying which patients will achieve meaningful symptom relief remains a significant challenge. EndoFLIP is increasingly used during G-POEM to assess pyloric physiology, yet its predictive value in determining clinical success has yet to be clearly established.

In this systematic review and meta-analysis, we observed an overall clinical success rate exceeding 70%, reinforcing the therapeutic role of G-POEM across gastroparesis subtypes. Both CSA and DI increased significantly following the procedure, confirming measurable changes in pyloric compliance.

However, neither postprocedural CSA nor DI reliably distinguished responders from nonresponders. Interestingly, CSA appeared to demonstrate a stronger association with symptom improvement than DI. Because DI incorporates pressure dynamics and may be influenced by technical or physiologic variability, CSA, a more direct anatomical measure of pyloric opening, may represent a more stable marker of pyloric dysfunction. This raises important questions regarding whether CSA may serve as a more consistent biomarker of therapeutic response.

Although EndoFLIP remains valuable for documenting intraprocedural physiologic changes, its role as a standalone predictor of long-term clinical success remains uncertain. Future prospective studies with standardized measurement protocols and longer follow-up are needed to better define how impedance planimetry should be integrated into patient selection and postprocedural management.

As G-POEM techniques continue to evolve, combining physiologic assessment tools with careful clinical evaluation will be essential in refining outcomes and optimizing care for patients with refractory gastroparesis.

Forest plot of pre– and post–G-POEM distensibility index in clinical responders. G-POEM, Gastric peroral endoscopic myotomy.

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