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 Tan; Sachin Mulmi Shrestha; Ming Wei; Panpan Wang; Jinjun Shi; Yanjia Lu; Qi Gao; Tong Lu; Jun Zhou; Ruihua Shi

doi:10.1007/s00464-020-07793-0

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

Surg Endosc. 2021 Jul;35(7):3459-3470. doi: 10.1007/s00464-020-07793-0. Epub 2020 Sep 3.

Authors

Jiacheng Tan¹, Sachin Mulmi Shrestha¹, Ming Wei¹, Panpan Wang¹, Jinjun Shi², Yanjia Lu², Qi Gao², Tong Lu³, Jun Zhou⁴, Ruihua Shi⁵

Affiliations

¹ Department of Gastroenterology, Zhongda Hospital Southeast University, No. 87 Dingjiaqiao, Nanjing, 210009, Jiangsu, China.
² Department of Ultrasound, Zhongda Hospital Southeast University, Nanjing, 210009, Jiangsu, China.
³ Department of Radiology, Zhongda Hospital Southeast University, Nanjing, 210009, Jiangsu, China.
⁴ Medical Division, Yidu Cloud (Beijing) Technology Co., Ltd, Beijing, 100191, China.
⁵ Department of Gastroenterology, Zhongda Hospital Southeast University, No. 87 Dingjiaqiao, Nanjing, 210009, Jiangsu, China. ruihuashi@126.com.

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 < 0.0001). For different anastomotic site, a significant improvement of GCSI was found at 6 month post-G-POEM (F_4,165 = 74.18, p < 0.0001). Subscale analysis of GCSI showed that nausea/vomiting, post-prandial fullness/early satiety, and bloating were improved significantly at 6-month post-G-POEM (p < 0.0001, respectively). Half-emptying and whole-emptying time were significantly shortened in patients with different anastomotic site post-G-POEM (half-emptying time: F_3,174 = 65.44, p < 0.0001; whole-emptying time: F_3,174 = 54.85, p < 0.0001). The emptying of ioversol was obviously accelerated after G-POEM. GCSI wasn't related to pyloric length, pyloric diameter, and thickness of pyloric wall. GERDQ was also used to evaluate the clinical efficacy of G-POEM. For each time points, GERDQ didn't differ significantly in patients with different anastomotic site (F_4,104 = 0.8075, p = 0.5231). For patients with different anastomotic site, GERDQ was improved significantly at different time points (F_4,104 = 59.11, p < 0.0001). The higher the esophageal anastomotic site was, the faster G-POEM improved the symptoms of gastroesophageal reflux. No one required re-hospitalization for any complication.

Conclusion: G-POEM is a minimally invasive therapy with long-term effectiveness and safety in treating postsurgical gastroparesis.

Keywords: G-POEM; GCSI; GERDQ; Gastric emptying; Postsurgical gastroparesis; The anastomotic site.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Esophageal Achalasia*
Esophageal Sphincter, Lower
Feasibility Studies
Gastric Emptying
Gastroparesis* / etiology
Gastroparesis* / surgery
Humans
Pyloromyotomy* / adverse effects
Pylorus / surgery
Retrospective Studies
Treatment Outcome