Efficacy of gastric per oral endoscopic myotomy for gastroparesis symptoms

Gastric Per Oral Endoscopic Myotomy (GPOEM) is a procedure used to improve gastroparesis (GP). The Gastroparesis Cardinal Symptom Index (GCSI) is used to assess symptoms subjectively. Although GPOEM has been shown to improve the GCSI score, the individual components of the symptom score have never been evaluated.

A prospective database was retrospectively reviewed for patients undergoing GPOEM for gastroparesis between January 2020 and June 2025. The GCSI individually reported nausea, retching, vomiting, stomach fullness, inability to finish a normal-sized meal, feeling excessively full after meals, loss of appetite, bloating, and abdominal distension, each rated on a scale of 0-5. Four-hour gastric emptying studies (GES) were collected.

A total of 167 patients underwent GPOEM during the study period, and 70 (42.0%) were included for having both preoperative and postoperative GCSI available at a mean of 3 months post-GPOEM. Fifty-two (31.1%) of the included cohort also had preoperative and postoperative GES. On average, GCSI and GES values were significantly improved after GPOEM with variable individual responses. Mean GCSI reduced from 26.9 to 16.4 (- 10.4, p < 0.001). Every individual component of the GCSI showed statistically significant improvement, with the largest with loss of appetite (- 1.4, p < 0.001) and belly visibly larger (- 1.4, p < 0.001). Mean GES improved from 42.4% to 19.8% (- 23.8%, p < 0.001).

This study specifically focused on the effect of GPOEM on each individual component of the GCSI. All symptom scores improved significantly at the cohort level, with the numerically greatest benefits seen in loss of appetite and a visibly larger belly, followed by nausea, vomiting, and stomach fullness. These findings provide additional descriptive information on individual symptom improvement and may help refine patient counseling, while still acknowledging that these data are exploratory in nature and require longer follow-up before allowing treatment-based decisions.