Severe and Refractory gastroparesis can be treated with endoscopic pyloromyotomy: BMJ

A recent study finds endoscopic pyloromyotomy (G-POEM), a minimally invasive treatment option for patients with gastroparesis, improves the symptoms and also gastric emptying 6 months post procedure. The findings were published in British Medical Journal - Gut.

This prospective randomized trial compared G-POEM with sham in patients with severe gastroparesis. The primary outcome was the proportion of patients with treatment success (defined as a reduction of at least 50% in the Gastroparesis Cardinal Symptom Index (GCSI) at 6 months). Patients were randomized to the sham group with persistent symptoms and offered crossover G-POEM. Enrollment was suspended after an interim analysis by the Information and Security Control Authority prior to the planned sample of 86 patients.

The key highlights of the study were:

A total of 41 patients (17 diabetic, 13 postoperative, 11 idiopathic; 6% male) were randomized into G-POEM and sham groups (21:20).

The treatment success rates were 71% (95% CI 50-86) after G-POEM and 22% (8-47) after sham (p = 0.005).

Treatment success rates in patients with diabetic, postoperative and idiopathic gastroparesis were 89% (95% CI 56–98), 50% (18 - 82) and 67% (30 - 90) after G-POEM; In the sham group, the corresponding figures were 17% (3-57), 29% (7-67) and 20% (3-67).

Mean gastric retention at 4 hours decreased from 22% (95% CI 17-31) to 12% (5-22) after G-POEM and was unchanged after sham: 26% (18-39) vs. 24% (11–35).

12 patients underwent G-POEM treatment, of which 9 (75%) were successful.

G-POEM for severe gastroparesis was superior to sham procedures in improving both symptoms and gastric emptying 6 months after the procedure according to the extensive findings of this study.

Source:

Martinek, J., Hustak, R., Mares, J., Vackova, Z., Spicak, J., Kieslichova, E., Buncova, M., Pohl, D., Amin, S., & Tack, J. (2022). Endoscopic pyloromyotomy for the treatment of severe and refractory gastroparesis: a pilot, randomised, sham-controlled trial. Gut, 71(11), 2170–2178. https://doi.org/10.1136/gutjnl-2022-326904