Endoscopic and surgical treatment options for gastroparesis: systematic review and network meta-analysis

Gastroparesis is a chronic gastric motility disorder characterized by delayed gastric emptying in the absence of mechanical obstruction. Patients often experience nausea, vomiting, bloating, and early satiety. Several treatment options exist, including dietary changes, pharmacological agents, botulinum toxin injection, gastric electrical stimulation (GES), pyloroplasty, and gastric per-oral endoscopic myotomy (G-POEM). However, comparative effectiveness data are limited.

A systematic review and network meta-analysis (NMA) was conducted to evaluate the relative effectiveness of interventions for gastroparesis. A literature search in PubMed, Google Scholar, and Cochrane CENTRAL (1982 to 31 May 2024) identified studies involving adults with scintigraphically confirmed gastroparesis and symptom assessment using the Gastroparesis Cardinal Symptom Index (GCSI) or Total Symptom Score (TSS). A DerSimonian-Laird random-effects meta-analysis and NMA with standardized mean differences were performed. Treatments were ranked using P scores.

A total of 55 studies met the inclusion criteria. G-POEM, pyloroplasty, GES, and botulinum toxin A were eligible for quantitative analysis. All interventions showed significant short-term symptom improvement. G-POEM had the greatest short-term effect and improved gastric emptying. At intermediate follow-up (>3-36 months), GES showed the highest efficacy. Long-term data (>36 months) were only available for G-POEM. GES was the only intervention assessed in sham-controlled trials, demonstrating superiority over placebo.

G-POEM and GES are the most effective treatments for gastroparesis. These findings support a tiered approach, integrating G-POEM for short-term symptom relief and GES for sustained improvement, depending on the clinical setting and availability.