Gastric myoelectrical activity based AI-derived threshold predicts resolution of gastroparesis post-pyloric balloon dilation

Abstract

Background: A patient subset with gastroparesis (GP) has normal gastric myoelectrical activity (GMA) and pyloric dysfunction.

Aims: (1) To determine pyloric balloon dilation (BD) effect on symptoms and gastric emptying in GP patients with normal 3 cycles per minute (cpm) GMA. (2) To demonstrate GMA-based artificial intelligence (AI)-derived formulae predict BD success at 10-12-month follow-up.

Methods: Cohort subjects completed baseline electrogastrogram w/water load satiety test (WLST), solid-phase nuclear gastric emptying, Gastrointestinal Cardinal Symptom Index (ANMS GCSI-DD) and Leeds questionnaires. Subjects were divided into two groups based on response to the WLST. Group 1 (n = 26) with hypernormal/normal 3 cpm GMA and Group 2 (n = 4) hyponormal/normal range 3 cpm GMA, compared to healthy normals. All subjects underwent endoscopic pyloric BD. After 10-12 months, gastric emptying and dyspepsia questionnaires were repeated to evaluate outcomes.

Results: Group 1 ANMS GCSI-DD scores improved from 2 points at baseline (BL) to 0 at follow-up (f/u) (p < 0.001); Group 2 ANMS GSCI-DD scores were 2 at BL and 1.6 at f/u (p = 0.25). Leeds scores improved (p < 0.001) only for Group 1. Group 1 gastric emptying improved (54.5% retained at 2 h at BL vs. 12.2% at f/u, p < 0.001) in contrast to Group 2 patients (51.25% at BL vs. 56.25% at f/u, p = 0.252). Percentage 3 cpm GMA decreased (41.1% at BL vs. 24.9% at f/u, p ≤ 0.005) in Group 1 versus Group 2 (15.3% at BL vs. 23.4% at f/u, p = 0.114). AI-derived GMA threshold (GMAT) of 0.59 predicted positive pyloric BD outcomes at 10-12 months with sensitivity 96%, specificity 75%, and 93% correct classification.

Conclusions: Pyloric BD improved symptoms and gastric emptying long term in patients with GP and hypernormal/normal 3 cpm GMA. AI-derived GMAT predicted pyloric BD success. GMA post-WLST and GMAT are objective measures for improved selection and outcomes for endoscopic pyloric BD.

Keywords: Artificial intelligence derived threshold; Electrogastrography; Gastric myoelectrical activity; Gastroparesis; Pyloric balloon dilation; Water load satiety test.