Gastric Per-Oral Endoscopic Myotomy Versus Pyloromyotomy for Gastroparesis: An International Comparative Study.

Abstract

INTRODUCTION\nGastroparesis is a potentially debilitating gastric motility disorder with limited treatment options. Highest efficacy treatments include gastric peroral endoscopic myotomy (GPOEM) and surgical pyloromyotomy. This study compares the efficacy and safety of GPOEM versus laparoscopic pyloromyotomy for refractory gastroparesis.\n\n\nMETHODS\nPatients who underwent GPOEM or laparoscopic pyloromyotomy for refractory gastroparesis from 4 centers across the US and Latin America were included in a dedicated registry. Data collected included patient demographics, imaging, laboratory values, clinical success, gastroparesis cardinal symptom index (GCSI), procedure time, pre- and post-op gastric emptying times, adverse events, and hospital length of stay (LOS).\n\n\nRESULTS\nA total of 102 patients were included (mean age 47; 32.4% male): GPOEM n=39, surgical pyloromyotomy n=63.Technical success was 100% in both groups. Clinical success was 92.3% in the GPOEM group and 82.5% in the surgery group (p=0.164). The GPOEM group had a significantly higher post-op GSCI score reduction by 1.3 units (p<0.00001), post-op retention reduction at 2 hours by 18% (p<0.00001), post-op retention reduction at 4 hours by 25% (p<0.00001) and a lower procedure time by 20 minutes (p<0.00001) as compared to surgery. GPOEM also had a lower hospital LOS by 2.8 days (p<0.00001). Adverse events were significantly fewer in the GPOEM group (13%) compared to surgery group (33.3%; p=0.021). Mean blood loss in the GPOEM group was only 3.6 ml compared to 866 ml in the surgery group.\n\n\nCONCLUSIONS\nGPOEM may be a less invasive, safer, and more efficacious procedural treatment for refractory gastroparesis as compared to surgical pyloromyotomy.