Clinical Outcomes Among Patients With Gastroparesis Undergoing Gastric Peroral Endoscopic Myotomy (G-POEM) Versus Surgical Pyloroplasty

Document Type

Conference Proceeding

Publication Date

10-1-2024

Publication Title

Am J Gastroenterol

Abstract

Introduction: Gastroparesis is a common disease with severity ranging from mild to refractory, which can pose challenges to both the patient and the provider. The available interventions directed at the pylorus are gastric peroral endoscopic myotomy (G-POEM) and surgical pyloroplasty. We aimed to investigate the peri-operative outcomes and complications in patients with gastroparesis undergoing G-POEM versus surgical pyloroplasty using a national database. Methods: Using the combined releases of the year 2016 of the National Inpatient Sample (NIS) database, we identified primary gastroparesis hospitalizations who were treated with G-POEM versus surgical pyloroplasty, using the International Classification of Diseases, Tenth Revision (ICD-10) codes. Univariable and multivariable regression analyses were performed to examine outcomes, including mortality, length of stay, and total healthcare charges. Baseline patient characteristics were evaluated using t-test and chi-square tests. STATA (IC-16.1 version; STATA Corp, College Station, TX) was used for the statistical analyses. Results: Among a total of 9,951 patients with gastroparesis, 8,966 underwent G-POEM and 985 underwent surgical pyloroplasty. Patients who underwent G-POEM were more likely to be younger (mean age 45.3 61.3 vs 61.5 60.88, P< 0.001) and were less likely to have hypertension (33.5% vs 47.9%, P< 0.001) and coronary artery disease (8.01% vs 19.1%, P< 0.001) (Figure 1). In regards to peri-operative outcomes, patients who underwent G-POEM had a significantly shorter length of stay (8.1 vs 13.1 days, Coef. -3.22 [-5.24 to -1.19], P=0.002), lower incidence of post-operative respiratory failure (adjusted odds ratio [aOR] 0.07 [0.01 to 0.47], P=0.007), were less likely to be discharged to a skilled nursing facility (aOR 0.44 [0.27 to 0.71], P< 0.001) and had a significantly lower total hospital charge (Coef. -65,175.71 [-102,172 to -28,179.39], P< 0.001). There was no significant difference in all-cause mortality, post-operative gastrointestinal bleeding, operative injury to the gastrointestinal tract and the need for blood transfusion (Table 1). Conclusion: Our analysis suggests that while there is no difference in mortality between patients with gastroparesis who underwent G-POEM versus surgical pyloroplasty, G-POEM was associated with significantly reduced healthcare resource utilization. Further prospective studies are warranted to evaluate the efficacy and safety of G-POEM versus surgical pyloroplasty in patients with gastroparesis.

Volume

119

Issue

10

First Page

S1629

Last Page

S1630

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