Gastric peroral endoscopic pyloromyotomy for decompensated gastroparesis: comprehensive motility analysis in relation to treatment outcomes

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Abstract

Background and study aims There are no reliable data to predict which patients with gastroparesis (GP) would benefit the most from gastric peroral endoscopic pyloromyotomy (G-POEM). The aim of the present study was to assess whether antro-duodenal motility patterns and pyloric distensibility can predict the outcome of G-POEM in patients with decompensated GP.Patients and methods In an open-label study, patients with GP and refractory symptoms were eligible for treatment with G-POEM if treatment attempts according to a standardized stepwise protocol had failed. Baseline assessment included Gastroparesis Cardinal Symptom Index (GCSI), C13-octanoic gastric emptying breath test and high-resolution antro-duodenal manometry. Pyloric distensibility using EndoFlip measurements was assessed at baseline and 3 months after the procedure. Explorative analyses were performed on potential predictors of response using logistic regression analyses.Results Twenty-four patients with decompensated GP underwent G-POEM. At baseline, 78.3% and 61.9% of patients showed antral hypomotility and neuropathic motor patterns, respectively. The technical success rate was 100% (24/24). Mean GCSI improved significantly at 3, 6, and 12 months after G-POEM ( P =0.01). Median distensibility index (DI) improved significantly as compared with baseline (7.5 [6.9;11.7] vs. 5.3[3.1;8.1], P =0.004). A significant correlation was found between clinical response at 6 months and pyloric DI improvement ( P =0.003). No potential predictors of clinical response after G-POEM could be identified in an explorative analysis.Conclusions G-POEM improved pyloric distensibility patterns in patients with decompensated GP. Clinical response at 6 months after G-POEM was associated with pyloric distensibility improvement. However, no potential predictors of response could be identified from either antro-duodenal motility patterns or pyloric distensibility.
Original languageEnglish
Pages (from-to)E137-E144
Number of pages8
JournalEndoscopy international open
Volume09
Issue number02
DOIs
Publication statusPublished - 1 Feb 2021

Keywords

  • diabetics
  • endoflip
  • myotomy g-poem
  • nausea
  • pylorus
  • PYLORUS
  • MYOTOMY G-POEM
  • NAUSEA
  • ENDOFLIP
  • DIABETICS

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