Endoscopic findings do not predict per-oral pyloromyotomy (POP) response

Area of Science:

• Gastroenterology
• Surgical Endoscopy

Background:

• Gastroparesis is a chronic condition impairing stomach emptying, often idiopathic, diabetic, or postoperative.
• Endoscopic per-oral pyloromyotomy (POP) is a primary treatment for medically refractory gastroparesis.
• Predicting successful outcomes after POP remains a clinical challenge.

Purpose of the Study:

• To evaluate the clinical response and outcomes of the per-oral pyloromyotomy (POP) procedure for gastroparesis.
• To identify potential predictors of clinical response following POP.
• To assess the correlation between endoscopic findings and patient outcomes.

Main Methods:

• Retrospective review of patients undergoing POP by a single endoscopist.
• Prospective collection of endoscopic data and postoperative surveys.
• Clinical response defined as a significant decrease in Gastroparesis Cardinal Symptom Index (GCSI); secondary outcome was normalization of gastric emptying study (GES).

Main Results:

• 39% of patients achieved a significant clinical response (≥1.0 decrease in GCSI), with 66% reporting overall symptom improvement.
• 50% of postoperative gastric emptying studies normalized.
• No significant preoperative or endoscopic predictors of clinical response were identified, though a higher baseline GCSI trended towards significance.

Conclusions:

• Endoscopic findings during POP do not reliably predict clinical response.
• The current GCSI metric may not fully capture the clinical picture of treatment success.
• Long-term durability and patient selection for endoscopic myotomy in gastroparesis require further investigation.