Long-term outcomes (≥3 years) after gastric peroral endoscopic myotomy for refractory gastroparesis: a systematic...

Gastric peroral endoscopic myotomy (G-POEM) has emerged as a novel management option for patients with refractory gastroparesis. Although G-POEM has shown excellent short-term outcomes, clinical success with symptom resolution in the long-term setting is still being investigated. As such, our aim was to investigate long-term outcomes after G-POEM in patients with gastroparesis.

Multiple databases were searched from inception until March 2023 for studies looking at long-term outcomes (≥3 years) for patients with gastroparesis treated with G-POEM. The primary outcome was clinical success 3 years after G-POEM. Secondary outcomes included changes in Gastroparesis Cardinal Symptom Index score before and 36 months after G-POEM, technical success, adverse events, and length of hospital stay. Quality assessment of studies was performed by using the Qumseya scale.

Five studies were included with 560 patients (average age, 47.03 years; 67.8% female) over a mean follow-up of 38.4 months. The pooled rate of clinical success at 36 months was 75% (95% confidence interval [CI], 68.2-80.5; I ² = 20%). Mean Gastroparesis Cardinal Symptom Index scores significantly decreased 36 months after the procedure standardized mean difference, 3.3; 95% CI, 1.8-4.7; I ²  = 94%). The pooled rate of technical success was 98.6% (95% CI, 91-99.8; I ² = 70%). Among adverse events, the pooled rate of perforation was .7% (95% CI, .2-2.4; I ² = 0%), bleeding was 4.1% (95% CI, 2.7-6.3; I ²= 0%), pain was .9% (95% CI, .3-3.1; I ² = 0%), and others (clip dislodgement, prepyloric ulcer, or mucosal tear) were 3.4% (95% CI, 2.1-5.5; I ² = 0%). The mean duration of hospital stay was a standardized mean difference of 3.06 days (95% CI, 2.6-3.5; I ² = 91%).

G-POEM has a durable long-term clinical success rate. Further studies are needed to identify patient selection factors that will enhance its clinical success.