Gastric peroral endoscopic myotomy for management of refractory gastroparesis in patients with gastric neurostimulator devices: a multicenter retrospective case control study

• Published in: Gastrointestinal endoscopy 2023-10, Vol.98 (4), p.559-566.e1
• Main Authors: Ichkhanian, Yervant, Al-Haddad, Mohammad A., Jacobs, Chelsea C., Schlachterman, Alexander, Yang, Juliana, Canakis, Andrew, Kim, Raymond, Guerson-Gil, Arcelia, D’Souza, Lionel S., Alsheik, Eva, Ginnebaugh, Brian D., Khashab, Mouen A., Zuchelli, Tobias, McFarlin, Kellie, Piraka, Cyrus, Nimri, Faisal, Arevalo-Mora, Martha, Harris, Kevin, Ashraf, Taha, Denha, Eric, Rahim, Ali, Obri, Mark, Gouda, Zane, Bilello, Justin L.
• Format: Article
• Language: English
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2023.04.2079

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. This was a multicenter, retrospective, matched case-control study. Consecutive patients with a GNS device and who underwent G-POEM as a salvage therapy for clinical failure (cases) and patients without GNS implantation and who underwent G-POEM for refractory gastroparesis (control) between October 2018 and August 2021 were included. The primary outcome was clinical success after G-POEM. A total of 123 patients (mean age 45.7 ± 14.7 years; 88 female subjects [72%]) underwent G-POEM therapy during the study: 41 cases and 82 controls. Clinical success was achieved in 66% in the case group and 65% in the control group (P = .311), during a median total clinical follow-up time of 11.8 (interquartile range, 2.4-6.3) months. In the case group, the mean Gastroparesis Cardinal Symptom Index score decreased from 2.8 ± 1.8 to 1.5 ± 1.9 (P = .024), and gastric retention at 4 hours improved from 45% ± 25.8% to 16.6% ± 13.1% (P = .06). The mean delta improvement in the subscales of nausea/vomiting (1.3 ± .6 vs .9 ± 1.1, P = .044) and bloating (1.6 ± 1.3 vs 1.2 ± 1.4, P = .041) were significantly higher in cases than in controls. 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.