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

Journal: Alimentary pharmacology & therapeutics 2022;55(2):168-177

PMID: 34854102

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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 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.

Address: Division of Gastroenterology, University of California-San Francisco, San Francisco, California, USA.; Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.; Mulford Health Sciences Library, University of Toledo, Toledo, Ohio, USA.; Department of Medicine, University of Toledo, Toledo, Ohio, USA.; Division of Gastroenterology, Virginia Commonwealth University, Richmond, Virginia, USA.; Department of Medicine, University of Toledo, Toledo, Ohio, USA.; Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.; Department of Medicine, Loyola Medicine/MacNeal Hospital, Berwyn, Illinois, USA.; Division of Gastroenterology, University of Toledo, Toledo, Ohio, USA.; Division of Gastroenterology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.

DOI: 10.1111/apt.16725

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MeSH Terms: Esophageal Achalasia, Esophageal Sphincter, Lower, Gastroparesis, Humans, Pyloromyotomy, Treatment Outcome