Gastric per-oral endoscopic myotomy (G-POEM) for refractory gastroparesis: Results from an international prospective trial

Kia Vosoughi, Yervant Ichkhanian, Petros Benias, Larry Miller, A. Aziz Aadam, Joseph R. Triggs, Ryan Law, William Hasler, Nicole Bowers, Dalton Chaves, Alberto M. Ponte-Neto, Peter Draganov, Dennis Yang, Maan El Halabi, Omid Sanaei, Olaya Isabella Brewer Gutierrez, Robert Stephen Bulat, John Pandolfino, Mouen Khashab

Research output: Contribution to journalArticlepeer-review

21 Scopus citations

Abstract

Although gastric per-oral endoscopic myotomy (G-POEM) is considered a promising technique for the management of refractory gastroparesis, high-quality evidence is limited. We prospectively investigated the efficacy and safety of G-POEM in unselected patients with refractory gastroparesis. Design In five tertiary centres, patients with symptomatic gastroparesis refractory to standard medical therapy and confirmed by impaired gastric emptying were included. The primary endpoint was clinical success, defined as at least one score decrease in Gastroparesis Cardinal Symptom Index (GCSI) with ≥25% decrease in two subscales, at 12 months. GCSI Score and subscales, adverse events (AEs) and 36-Item Short Form questionnaire of quality of life were evaluated at baseline and 1, 3, 6 and 12 months after G-POEM. Gastric emptying study was performed before and 3 months after the procedure. Results Of 80 enrolled patients, 75 patients (94%) completed 12-month follow-up. Clinical success at 12 months was 56% (95% CI, 44.8 to 66.7). GCSI Score (including subscales) improved moderately after G-POEM (p<0.05). In a regression model, a baseline GCSI Score >2.6 (OR=3.23, p=0.04) and baseline gastric retention >20% at 4 hours (OR=3.65, p=0.03) were independent predictors of clinical success at 12 months, as was early response to G-POEM at 1 month after therapy (OR 8.75, p<0.001). Mild procedure-related AEs occurred in 5 (6%) patients. Conclusion G-POEM is a safe procedure, but showed only modest overall effectiveness in the treatment of refractory gastroparesis. Further studies are required to identify the best candidates for G-POEM; unselective use of this procedure should be discouraged. Trial registration number ClinicalTrials.gov Registry NCT02732821.

Original languageEnglish (US)
Pages (from-to)25-33
Number of pages9
JournalGut
Volume71
Issue number1
DOIs
StatePublished - Jan 1 2022

Keywords

  • gastric emptying
  • gastrointesinal endoscopy
  • gastroparesis

ASJC Scopus subject areas

  • Gastroenterology

Fingerprint

Dive into the research topics of 'Gastric per-oral endoscopic myotomy (G-POEM) for refractory gastroparesis: Results from an international prospective trial'. Together they form a unique fingerprint.

Cite this