Feasibility, safety, and long-term efficacy of gastric peroral endoscopic myotomy (G-POEM) for postsurgical gastroparesi
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and Other Interventional Techniques
Feasibility, safety, and long‑term efficacy of gastric peroral endoscopic myotomy (G‑POEM) for postsurgical gastroparesis: a single‑center and retrospective study of a prospective database Jiacheng Tan1 · Sachin Mulmi Shrestha1 · Ming Wei1 · Panpan Wang1 · Jinjun Shi2 · Yanjia Lu2 · Qi Gao2 · Tong Lu3 · Jun Zhou4 · Ruihua Shi1 Received: 4 January 2020 / Accepted: 7 July 2020 © The Author(s) 2020
Abstract Background Postsurgical gastroparesis is recognized as a gastrointestinal dysfunction syndrome following foregut surgery. Gastric peroral endoscopic myotomy (G-POEM) is suggested as a minimally invasive therapy for gastroparesis. But the long-term efficacy and safety of G-POEM in treating postsurgical gastroparesis are rarely explored. Methods The primary outcomes included the symptomatic improvement based on gastroparesis cardinal symptoms index (GCSI) and the improvement of gastric emptying. The secondary outcomes included the improvement of gastroesophageal reflux symptoms and complications of G-POEM. Results The severity of postsurgical gastroparesis was not associated with the onset time and the course of the disease. G-POEM significantly reduced GCSI throughout the follow-up period (p 40 cm
Table 2 Overall clinical effectiveness of G-POEM
65.74 ± 11.11 22/57 19.74 ± 3.54 4 (1.5, 10) 29 50 1 (0.5, 6) 43 36
In all the 79 patients, neither pyloric stenosis nor hypertrophy was found before G-POEM. The patient’s baseline information is shown in Table 1. All procedures were technically successful. Mean length of myotomy was 2.53 ± 0.52 cm. Mean duration of procedure was 26.35 ± 4.15 min. All mucosal entry points were closed with 3–8 hemostatic clips. Mean postsurgical fasting time was 2.23 ± 0.44 days. Mean length of hospital stay was 5.35 ± 0.82 days. According to the onset time of postsurgical gastroparesis, patients were divided into two groups: gastroparesis occurred within two years after surgery, gastroparesis occurred two years or longer after surgery. The severity of gastroparesis symptoms was not associated with the onset time (GCSI: 2.98 ± 0.64 vs. 2.96 ± 0.59, p = 0.551). Based on the course of gastroparesis, patients were divided into two groups: the duration of gastroparesis ≤ 1 year, the duration of gastroparesis > 1 year. The severity of gastroparesis symptoms was not associated with the course of the disease (GCSI: 2.98 ± 0.65 vs. 2.94 ± 0.53, p = 0.14).
The primary outcomes
35 33 3 5 1 1 1
The symptomatic improvement based on GCSI To evaluate the overall clinical effectiveness of G-POEM, GCSI was analyzed before G-POEM and 6-month, 12-month, 18-month, and 24-month post-G-POEM. At 6-month post-G-POEM, 77.2% of patients (61/79) achieved clinical responses with a decrease in mean GCSI from 2.97 ± 0.6 at baseline to 1.12 ± 0.77. At 12-month, 78.3% of patients (47/60) achieved clinical response with a mean GCSI of 1.04 ± 0.53. At 18-month, 74.5% (35/47) of patients achieved clinical responses with a mean GCSI of 1.22 ± 0.58. At 24-month, 81.8% (27/33) o
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