Gastroparesis peroral endoscopic myotomy (G-POEM) was found to be an effective 4 year treatment in patients with refractory gastroparesis (RG), according to a study published in Gastrointestinal Endoscopy.

Researchers retrospectively reviewed data that was collected from a prospective cohort at the National Medical Center Century XXI in Mexico between 2017 and 2021. Patients with confirmed RG (N=374), who underwent G-POEM, were evaluated for 4-year safety and efficacy outcomes.

Patients had a mean age of 48.4±15.7 years; 62.3% were women; Gastroparesis Cardinal Symptom Index (GCSI) score was 3.8±0.53; and they underwent G-POEM for a median of 24 (range, 2-66) months after RG diagnosis.


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Patients had diabetic (n=141), idiopathic (n=115), and postsurgical gastroparesis (n=102), as well as other (n=16) RG etiologies. The predominant RG symptoms differed on the basis of etiology (P =.031). Nausea and vomiting were the most common symptoms among the diabetic gastroparesis cohort (53.2%), satiety and gastric fullness were most common among the idiopathic cohort (41.8%), and bloating and abdominal pain were most common among the postsurgical (41.2%) and other (43.8%) groups.

The technical success rate was 100%. The procedure lasted 54.2±17.3 minutes, the tunnel length was 4.52±0.66 cm, and myotomy length was 3.38±0.63 cm.

During the 4-year follow-up, 12.3% were hospitalized, 19.2% had a recurrence, G-POEM failed among 3.2%, and death occurred among 1.9%.

GES normalization at 48 months occurred among 63.9% and 77.5% had final clinical success. Stratified by etiology, clinical success was highest among the cohort with diabetes (86.5%), followed by the idiopathic (75.6%), other (68.8%), and postsurgical (68.6%) groups. The clinical success rate was significantly higher among the cohort with diabetes compared with all other cohorts (all P £.011). No other significant differences in clinical success rates were observed.

Long-term clinical success was associated with diabetic etiology (odds ratio [OR], 5.113; 95% CI, 1.643-5.981; P =.035), GCSI score 1.5-2.5 at 6 months (OR, 3.612; 95% CI, 2.122-5.317; P =.022), predominant symptoms of nausea or vomiting (OR, 3.541; 95% CI, 1.881-5.511; P =.012), undergoing G-POEM less than 24 months after diagnosis (OR, 2.455; 95% CI, 1.129-3.522; P =.042), and Retention percentage at 4 hours (RP4H) less than 10% at 6 months (OR, 2.188; 95% CI, 1.435-4.233; P =.039).

Study limitations included the single-center design and the lack of a comparator group.

“…[I]n spite of the complex nature of this disease, our data confirms the good results after 4 years of evaluation with G-POEM in patients with RG, especially in those with diabetic etiology, placing it as a potential first-line therapy in these patients, especially in this subgroup,” the study authors noted.

Reference

Hernández Mondragón OV, García Contreras LF, Blanco Velasco G, Solórzano Pineda OM, Castillo Carrillo DM, Murcio Perez E. Gastroparesis peroral endoscopic myotomy outcomes after 4 years of follow-up in a large cohort of patients with refractory gastroparesis. Published online April 1, 2022. doi:10.1016/j.gie.2022.03.025