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G-POEM shows promise for relieving gastroparesis symptoms, improving QOL
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LAS VEGAS — The minimally invasive procedure called gastric per oral endoscopic pyloromyotomy, or G-POEM, demonstrated promising short-term outcomes for patients with gastroparesis, according to retrospective data presented at ACG 2016.
“We showed that ... G-POEM is a feasible approach for treating gastroparesis,” Sunil Dacha, MD, from Emory University School of Medicine, said during his presentation. “There was significant improvement in symptoms in most patients, and we showed an improvement in [Gastroparesis Cardinal Score Index (GCSI)], reduced gastric retention percentages on 4-hour [gastric emptying study (GES)] and significant improvements in quality of life domains.”
Dacha and colleagues reviewed data on 10 patients with refractory gastroparesis who underwent G-POEM (mean age, 47.3 years). Four patients had diabetic gastroparesis, four idiopathic, one post-infectious and one post-surgical. Eight were women, four were black and six were white.
Sunil Dacha
The procedure was successful in all patients with no adverse events, a mean procedural duration of 47.7 minutes, a mean myotomy length of 2.94 cm, and a mean length of stay of 2.5 days.
After a mean follow-up of 4.6 months, eight of the patients achieved clinical success, defined by reduced GCSI scores and no recurrent hospitalization.
Mean GCSI scores dropped from 30.1 to 12.8 in these patients (P = .0001), and GES normalized in five patients and improved in two. Additionally, mean 4-hour gastric retention on GES dropped from 62.5% to 25.4% (P = .009) after the procedure.
Several quality of life domains on the SF-36 questionnaire also improved significantly at follow-up, including bodily pain, general health, vitality, social functioning and mental health.
One of the patients did not respond and was hospitalized for nausea and vomiting 15 days after the procedure, and another did not experience improvement of symptoms.
In the future, “we need to identify the exact subset of patients that benefit from G-POEM, and we need to standardize the work-up and the procedural techniques as there is no uniform agreement on the procedural techniques at this point,” Dacha said. “We need to standardize measurement of outcomes, ... long-term outcomes data are needed,” and especially important is “training the future generation of endoscopists for G-POEM, which is essentially endoscopic surgery rather than an endoscopic procedure.” – by Adam Leitenberger
Reference:
Dacha S, et al. Abstract #2. Presented at: American College of Gastroenterology Annual Scientific Meeting; Oct. 17-19, 2016; Las Vegas, NV.
Disclosures: The researchers report no relevant financial disclosures.