Gastric Peroral Endoscopic Myotomy for Management of Refractory Gastroparesis in Patients with Gastric Neurostimulator Devices: A Multicenter Retrospective Case Control Study
Ichkhanian Y, Al-Haddad MA, Jacobs CC, Schlachterman A, Yang J, Canakis A, Kim R, Guerson-Gil A, D'Souza LS, Alsheik E, Ginnebaugh BD, Khashab MA, Zuchelli T, Kellie M, and Piraka C. Gastric Peroral Endoscopic Myotomy for Management of Refractory Gastroparesis in Patients with Gastric Neurostimulator Devices: A Multicenter Retrospective Case Control Study. Gastrointest Endosc 2023.
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.
ePub ahead of print