One-year results of gastric peroral endoscopic myotomy for refractory gastroparesis: a French multicenter study

摘要

Background: Data on the long-term outcomes of gastric peroral endoscopic myotomy (G-POEM) for refractory gastroparesis are lacking. We report the results of a large multicenter long-term follow-up study of G-POEM for refractory gastroparesis. Methods: This was a retrospective multicenter study of all G-POEM operations performed in seven expert French centers for refractory gastroparesis with at least 1 year of follow-up.The primary endpoint was the 1-year clinical success rate, defined as at least a 1-point improvement in the Gastroparesis Cardinal Symptom Index (GCSI). Results: 76 patients were included (60.5% women; age 56 years). The median symptom duration was 48 months. The median gastric retention at 4 hours (H4) before G-POEM was 45% (interquartile range [IQR] 29%67%). The median GCSI before G-POEM was 3.6 (IQR 2.84.0). Clinical success was achieved in 65.8% of the patients at 1 year, with a median rate of reduction in the GCSI score of 41%. In logistic regression analysis, only a high preoperative GCSI satiety subscale score was predictive of clinical success (odds ratio [OR] 3.41, 95% confidence interval [CI] 1.0111.54; P=0.048), while a high rate of gastric retention at H4 was significantly associated with clinical failure (OR 0.97, 95%CI 0.951.00; P=0.03). Conclusions: The results confirm the efficacy of G-POEM for the treatment of refractory gastroparesis, as evidenced by a 65.8% clinical success rate at 1 year. Although G-POEM is promising, prospective sham-controlled trials are urgently needed to confirm its efficacy and identify the patient populations who will benefit most from this procedure.