Management of Patients After Failed Gastric Peroral Endoscopic Myotomy: A Multi-Center Study

Document Type

Conference Proceeding

Publication Date

10-25-2023

Publication Title

Am J Gastroenterol

Abstract

Introduction: The heterogeneous and unpredictable clinical outcomes of gastric peroral endoscopic myotomy (G-POEM) in patients with refractory gastroparesis is a fundamental shortcoming of the procedure. The optimal management of patients who fail G-POEM is not known. We aimed to compare the outcomes of different management strategies in patients who had failed G-POEM. Methods: This was a multicenter retrospective study at 7 tertiary centers between 02/2020 and 10/2022. All patients who underwent G-POEM and experienced persistent (primary) or recurrent (secondary) symptoms were labeled as clinical failure and were included. Primary outcome was clinical success post re-treatment, defined as a 1-score decrease in average Gastroparesis Cardinal Symptom Index (GCSI) with a ≥ 25% decrease in at least 2 sub-scales post-G-POEM. Results: A total of 233 patients [mean age 47.8 ± 15.6, F 170 (73%)] underwent G-POEM for the management of refractory gastroparesis at 7 U.S. tertiary care centers, and 92 (39%) patients experienced clinical failure with a median GCSI score of 2.4 (IQR 2.1-3.3). The majority, 86 (93%), were primary clinical failures. Post-G-POEM GES was performed in 35 (38%) [abnormal in 14 (40%)], and diagnostic upper endoscopy in 57 (62%) [endoscopic findings suggestive of gastroparesis 35 (83%)]. During the duration of the study, a total of 25 (27%) underwent re-treatment, while 67 (73%) underwent pharmacologic and/or palliative symptomatic treatment (Table 1). Among the patients who underwent re-treatment, clinical success was achieved in 12 (46%) of the patients during a median duration follow-up of 9.4 (IQR 6-13) months, with a decrease in the median GCSI score from 2.8 ± 1.6 to 1.5 ± 1.8, (P = 0.024). A total of 9 patients in the re-treatment group underwent both pre- and post-retreatment GES with an improvement in gastric retention at 4 hrs. from 38 ± 20.83 % to 23 ± 19.7 %, (P = 0.124). The highest clinical success was achieved among patients with GNS, 5 (83%), followed by repeat G-POEM, 4 (67%) (Figure 1). Having abnormal GES post-G-POEM was found to be the only independent predicting factor (OR 1.6, P = 0.031) for clinical success post-re-treatment. Concomitant gastrointestinal pathologies were noted in 6 (6.5%) (esophageal dysmotility treatment 2, sphincter of Oddi dysfunction 1, candida esophagitis 3). Conclusion: In our cohort, 46% of patients with clinical failure post-G-POEM had clinical success after re-treatment, with abnormal GES post-failed G-POEM being a predictor of clinical response.

Volume

118

Issue

10

First Page

S1410

Last Page

S1411

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