Systematic Review With Meta-analysis

One-year Outcomes of Gastric Peroral Endoscopic Myotomy for Refractory Gastroparesis

Faisal Kamal; Muhammad Ali Khan; Wade Lee-Smith; Sachit Sharma; Ashu Acharya; Dawit Jowhar; Umer Farooq; Muhammad Aziz; Abdul Kouanda; Sun-Chuan Dai; Colin W. Howden; Craig A. Munroe

Disclosures

Aliment Pharmacol Ther. 2022;55(2):168-177. 

In This Article

Abstract and Introduction

Abstract

Background: Several studies have examined the efficacy of gastric peroral endoscopic myotomy (G-POEM) for gastroparesis.

Aim: To evaluate the mid-term efficacy of G-POEM by meta-analysis of studies with a minimum 1 year of follow-up.

Methods: We reviewed several databases from inception to 10 June 2021 to identify studies that evaluated the efficacy of G-POEM in refractory gastroparesis, and had at least 1 year of follow-up. Our outcomes of interest were clinical success at 1 year, adverse events, difference in mean pre- and 1 year post-procedure Gastroparesis Cardinal Symptom Index (GCSI) score, and difference in mean pre- and post-procedure EndoFLIP measurements. We analysed data using a random-effects model and assessed heterogeneity by I 2 statistic.

Results: We included 10 studies comprising 482 patients. Pooled rates (95% CI) of clinical success at 1 year and adverse events were 61% (49%, 71%) and 8% (6%, 11%), respectively. Mean GCSI at 1 year post-procedure was significantly lower than pre-procedure; mean difference (MD) (95% CI) −1.4 (−1.9, −0.9). Mean post-procedure distensibility index was significantly higher than pre-procedure in the clinical success group at 40 and 50 mL volume distension; standardised mean difference (95% CI) 0.82 (0.07, 1.64) and 0.91 (0.32, 1.49), respectively. In the clinical failure group, there was no significant difference between mean pre- and post-procedure EndoFLIP measurements.

Conclusions: G-POEM is associated with modest clinical success at 1 year. Additional studies with longer follow-up are required to evaluate its longer-term efficacy.

Introduction

Gastroparesis is characterised by delayed gastric emptying in the absence of a mechanical obstruction. It causes debilitating symptoms such as nausea, vomiting, abdominal pain and early satiety, which can substantially impair quality of life.[1,2] The economic impact of gastroparesis is enormous due to high costs associated with inpatient admissions, emergency room visits, clinic visits, and procedures.[3,4] Data on the epidemiology of gastroparesis are limited. A population-based study from the UK found that the standardised prevalence of gastroparesis was 13.8 per 100 000 persons, and that the standardised incidence rose from 1.5 to 1.9 per 100 000 person-years between 2004 and 2016.[5] A previous population-based study from Olmsted county, Minnesota, USA, found that the age-adjusted incidence of gastroparesis was 6.3 per 100 000 person-years, and the age-adjusted prevalence was 24.2 per 100 000 persons.[6] There is also limited data on the natural history of gastroparesis. One study did not observe remarkable changes in gastric emptying or in symptoms in patients with diabetic gastroparesis during a follow-up of 12 years.[7] Chang et al found that gastric emptying was remarkably stable during >25 years of follow-up in patients with diabetic gastroparesis.[8]

Dietary modifications and pharmacologic agents such as dopamine D2 receptor antagonists are often used first line. The efficacy of these agents is greatly limited by serious side effects including dyskinesia and cardiac arrhythmias.[9,10] Randomised controlled trials have shown no significant improvement in gastroparesis with Botulinum toxin injection compared to placebo.[11,12] One study evaluating the efficacy of transpyloric stent placement in the management of refractory gastroparesis reported a response rate of 75%; however, stent migration rate was 59%.[13]

Gastric peroral endoscopic myotomy (G-POEM) was first introduced in 2013; since then, it has shown promising results in the management of refractory gastroparesis. Meta-analyses of studies with only short-term follow-up have established its initial efficacy and safety.[14–20] However, to date, no meta-analysis has evaluated its mid-term or long-term efficacy and/or safety. More recent studies with longer follow-up have evaluated the efficacy of G-POEM.[21–23] In this systematic review and meta-analysis, we have evaluated the mid-term efficacy of G-POEM by only including studies with a minimum of 1 year of follow-up.

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