Gastric Peroral Endoscopic Myotomy for Refractory Gastroparesis with a Median Follow-Up of 10 Months: An Indian...

Gastric peroral endoscopic myotomy has shown promising results for refractory gastroparesis. We share our Indian experience of gastric peroral endoscopic myotomy performed over the last 5 years.

This is a retrospective study of prospectively maintained data of patients who underwent gastric peroral endoscopic myotomy for refractory gastroparesis at our center. The primary outcome was to assess the clinical success at 3 months measured by ≥50% reduction of gastroparesis cardinal symptom index score from the baseline. The secondary outcomes were to assess the technical success, change in percentage retention at 4 h in gastric emptying scintigraphy at 6 months, change in gastroparesis cardinal symptom index score, Patient Assessment of Upper Gastrointestinal Disorders-Quality of Life score at 1, 6 months and 1 year, respectively, and adverse event rate graded by AGREE classification.

Between 2019 and 2024, 16 patients underwent gastric peroral endoscopic myotomy in our unit. The median (IQR) age was 40 (30.5, 48.75), and 10 were females (62.5%). The most common etiology was idiopathic (11/16, 68.8%). The clinical success at 3 months was 72.4% (8/11), which was sustained at 6 months and 1 year of follow-up to 71.7% (5/7). The technical success was 100%. There was a significant reduction in gastroparesis cardinal symptom index score, Patient Assessment of Upper Gastrointestinal Disorders-Quality of Life score at 1, 3, 6 months and 1 year. Similarly, there was a significant reduction in the percentage retention at 4 h in gastric emptying scintigraphy at 6 months. One patient needed intraoperative needle aspiration of the capnoperitoneum while another had hematemesis after discharge, which was managed conservatively.

Our first Indian experience of gastric peroral endoscopic myotomy for refractory gastroparesis shows similar outcomes compared to global literature with gastric peroral endoscopic myotomy emerging as a preferred modality in these subsets of patients.