SAGES surgical management of gastroparesis: systematic review and expert consensus

Gastroparesis is a debilitating disease for which therapeutic strategies achieve variable success. This systematic review and consensus statements address the surgical management of medically refractory gastroparesis.

A systematic review was conducted, with a literature search through December 31, 2024, addressing the surgical treatment of gastroparesis, including gastric electrical stimulation (GES), gastric per-oral endoscopic myotomy (GPOEM), pyloroplasty and pyloromyotomy, and gastrectomy. Studies assessing symptom resolution and changes in gastric emptying were extracted. The findings were subsequently presented to a panel of surgeons and gastroenterologists, some of whom are members of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), with the patient partner perspective considered. Consensus statements were generated from the presented data and subsequent discussion for each of the four treatment options.

All consensus statements were based on expert opinion due to poor and heterogeneous datasets for each intervention. The panel judged GES, pyloroplasty, and pyloromyotomy, including gastric per-oral endoscopic myotomy, to be reasonable treatments for patients with medically refractory gastroparesis. The panel does not suggest surgical resection as a standard treatment option for medically refractory gastroparesis, but acknowledges that in specific patient cases, it may be reasonable.

The consensus views achieved provide guidance for surgical approaches to medically refractory gastroparesis. The panel also highlighted evidence gaps that warrant research to strengthen the evidence base for surgical treatment strategies for gastroparesis.