Gastric peroral endoscopic myotomy for management of refractory gastroparesis in patients with gastric neurostimulator devices: a multicenter retrospective case control study

Background and Aims Gastric neurostimulation (GNS) and gastric peroral myotomy (G-POEM), therapies for refractory gastroparesis, are associated with suboptimal outcomes. We studied the role of G-POEM as a salvage therapy in patients with refractory symptoms after GNS implantation. Methods This was a multicenter, retrospective, matched case-control study. Consecutive patients with a GNS device and who underwent G-POEM as a salvage therapy for clinical failure (cases) and patients without GNS implantation and who underwent G-POEM for refractory gastroparesis (control) between October 2018 and August 2021 were included. The primary outcome was clinical success after G-POEM. Results A total of 123 patients (mean age 45.7 ± 14.7 years; 88 female subjects [72%]) underwent G-POEM therapy during the study: 41 cases and 82 controls. Clinical success was achieved in 66% in the case group and 65% in the control group (P = .311), during a median total clinical follow-up time of 11.8 (interquartile range, 2.4-6.3) months. In the case group, the mean Gastroparesis Cardinal Symptom Index score decreased from 2.8 ± 1.8 to 1.5 ± 1.9 (P = .024), and gastric retention at 4 hours improved from 45% ± 25.8% to 16.6% ± 13.1% (P = .06). The mean delta improvement in the subscales of nausea/vomiting (1.3 ± .6 vs .9 ± 1.1, P = .044) and bloating (1.6 ± 1.3 vs 1.2 ± 1.4, P = .041) were significantly higher in cases than in controls. Conclusions Among patients with refractory symptoms after GNS, G-POEM can be a reasonable salvage therapy to provide further symptomatic relief with evidence of a potential additive effect of both G-POEM and GNS. Abbreviations

Gastric Peroral Endoscopic Myotomy for Management of Refractory Gastroparesis in Patients with Gastric Neurostimulator Devices: A Multicenter Retrospective Case Control Study

BACKGROUND AND AIMS: Gastric neurostimulation (GNS) and gastric peroral myotomy (G-POEM), therapies for refractory gastroparesis, are associated with suboptimal outcomes. We studied the role of G-POEM as a salvage therapy in patients with refractory symptoms after GNS implantation. METHODS: This was a multicenter, retrospective, matched-case control study. Consecutive patients with GNS device and underwent G-POEM as a salvage therapy for clinical failure (cases) and patients without GNS implantation and underwent G-POEM for refractory gastroparesis (control) between 10-2018 and 08-2021 were included. The primary outcome was clinical success after G-POEM. RESULTS: A total of 123 patients (mean age 45.7 ± 14.7 years; 88 females [72%]) underwent G-POEM therapy during the duration of the study: 41 cases and 82 controls. Clinical success was achieved in 66% in the case group and 65% in the control, (P=0.311), during a median total clinical follow-up time of 11.8 (IQR: 2.4-6.3) months. In the case group, the mean Gastroparesis Cardinal Symptom Index (GCSI) decreased from 2.8 ± 1.8 to 1.5 ± 1.9, (P=0.024), and gastric retention at 4 hours improved from 45% ± 25.8 to 16.6% ± 13.1, (P=0.06). The mean delta improvement in the subscales of nausea/vomiting (1.3 ± 0.6 vs. 0.9 ± 1.1; P=0.044) and bloating (1.6 ± 1.3 vs. 1.2 ± 1.4; P=0.041) were significantly higher in cases than in controls. CONCLUSIONS: Among patients with refractory symptoms after GNS, G-POEM can be a reasonable salvage therapy to provide further symptomatic relief with evidence of a potential additive effect of both G-POEM and GNS