Gastric Peroral Endoscopic Myotomy (G-POEM) as a Treatment for Refractory Gastroparesis: Long-Term Outcomes

Background and Aims. Gastric peroral endoscopic myotomy (G-POEM) has been regarded as a novel and minimally invasive therapy for refractory gastroparesis. This study reports the long-term outcomes and possible predictive factors for successful outcomes after G-POEMin an Asian population. Methods. This is a retrospective single-centre study of 16 patients who underwent G-POEMfor refractory gastroparesis fromAugust 2016 to October 2017. This study included 11 males and 5 females; in addition, 13 patients had postsurgical gastroparesis, and 3 patients had diabetes. The patients included had severe and refractory gastroparesis, as indicated by a GastroparesisCardinal SymptomIndex (GCSI) score >= 20, and evidence of a delay on gastric emptying scintigraphy (GES). The primary outcome parameter was an assessment of the long-term clinical efficacy of the procedure. The secondary outcome parameter was the detection of possible predictive factors for success and the determination of cut-off values for such predictors. Results. Technical success was achieved in 100% of the patients, with a mean procedure time of 45.25 +/- 12.96 min. The long-term clinical responsewas assessed in all patients during amedian follow-up of 14.5 months. Clinical successwas achieved in 13 (81.25%) patients. There was a significant reduction in theGCSI scores and GES values after the procedure compared to the baseline values, with P values of < 0.0001 and 0.012, respectively. Univariate regression analysis showed that theGCSI and GES had significant associations with the future clinical outcomes of the patients, but this finding was not confirmed in multivariate analysis. A GCSI cut-off score of <= 30 had a high sensitivity and a negative predictive value (NPV) of 100% for predicting a successful procedure. GES (half emptying time <= 221.6 min and 2-hour retention <= 78.6%) had a high specificity and a positive predictive value (PPV) of 100%. Conclusions. G-POEMis a safe and effective treatment option with a long-term efficacy of 81.6%. GCSI and GES could serve as good predictive measures.