Efficacy and safety of gastric peroral endoscopic myotomy across different etiologies of gastroparesis: systematic review and meta-analysis

Department

Internal Medicine

Document Type

Article

Publication Title

Gastrointestinal Endoscopy

Abstract

Background and aims: Gastric peroral endoscopic myotomy (G-POEM) is an emerging treatment for refractory gastroparesis. Although its efficacy and safety have been analyzed in previous systematic reviews and meta-analyses, no studies have compared its effectiveness based on etiology. Our study aims to evaluate the efficacy and safety of G-POEM by etiologies of gastroparesis.

Methods: We conducted a comprehensive search in major databases until October 2023, focusing on the efficacy and safety of G-POEM by etiology. Our primary outcome was clinical success based on etiology, with an additional subgroup analysis on Gastroparesis Cardinal Symptom Index (GCSI) scores before and after G-POEM based on etiology using standard meta-analysis methods and the random-effects model. Heterogeneity was assessed using I2 statistics.

Results: In our analysis of 15 studies (7 retrospective, 8 prospective) involving 982 patients (mean patient age, 50.81 years; mean follow-up, 21 months), postsurgical conditions were the most common etiology in G-POEM (290 cases), followed by idiopathic factors (287 cases) and diabetes (286 cases). Subgroup analysis revealed pooled clinical success rates of 65% (95% confidence interval [CI], 51-77; I2 = 46%) for diabetes, 70% (95% CI, 46-86; I2 = 73%) for postsurgical conditions, and 60% (95% CI, 41-77; I2 = 68%) for idiopathic etiologies. Our research also indicated that G-POEM significantly improved GCSI scores: 1.7 (95% CI, -.01 to 3.5; P = .052) for diabetes, 1.34 (95% CI, -.07 to 2.62; P = .038) for postsurgical conditions, and 1.5 (95% CI, .36-2.75; P = .01) for idiopathic patients.

Conclusions: Based on this meta-analysis, G-POEM is effective and safe for treating refractory gastroparesis irrespective of the etiology, with significant improvements in clinical success rates and GCSI scores.

First Page

54

Last Page

67.e6

DOI

10.1016/j.gie.2024.08.024

Volume

101

Issue

1

Publication Date

1-1-2025

Medical Subject Headings

Gastroparesis (etiology, surgery); Humans; Treatment Outcome; Pyloromyotomy (methods, adverse effects); Myotomy (methods, adverse effects); Natural Orifice Endoscopic Surgery (methods, adverse effects)

PubMed ID

39181473

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