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GPOEM improves gastroparesis symptoms, QOL
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Gastric per-oral endoscopic pyloromyotomy, or GPOEM, resulted in overall improvement in gastroparesis symptoms, as well as improved gastric emptying and quality of life, according to recent study data.
Healio Gastroenterology reported preliminary findings from this study at ACG 2016, and expanded data have now been published in Gastrointestinal Endoscopy.
To evaluate the clinical benefits of GPOEM in patients with medically refractory gastroparesis, Sunil Dacha, MD, and colleagues from Emory University School of Medicine, performed a retrospective study of 16 consecutive patients who underwent the procedure.
These included 13 women and three men with an average age of 44.76 years. Average procedure time was 49.7 minutes, average myotomy length was 2.94 cm, and average length of hospital stay was 2.46 days.
Eighty-one percent had significant improvements in their average Gastroparesis Cardinal Symptom Index vs. baseline (at 1 month, n = 16: P = .0001; at 6 months, n = 13: P < .01; at 1 year, n = 6: P < .01). Further, their SF-36 scores showed significant improvements in several QOL domains that lasted through 6 months of follow-up. Finally, gastric emptying scans showed average 4-hour gastric retention dropped from 62.9% to 17.6% (P = .007).
No patients experienced adverse events related to the procedure.
“To our knowledge, this is the first report of improvement of quality of life in patients with medically refractory gastroparesis after GPOEM,” Dacha and colleagues wrote. “Even though GPOEM has shown promising results, as seen in our study, the procedure is not widely available. It remains a complex procedure only performed by highly experienced endoscopists in high-volume centers. Whether the procedure can be generalized and the same results can be achieved by less-experienced endoscopists remain in question,” they added.
They also noted that there is a lack of consensus on the procedural technique of GPOEM, and that future research should identify subsets of gastroparesis patients who would benefit from the procedure.
In a related editorial, Lee L. Swanström, MD, FACS, FASGE, FRCSEng, of the Institute of Image Guided Surgery at IHU-Strasbourg in France, and The Oregon Clinic in Portland, Oregon, suggested that GPOEM, once refined, may be appropriately placed early in the treatment algorithm.
“Because it is less expensive than gastric stimulators or stents, less invasive than surgery, apparently much more effective than Botox, and has less maintenance than tubes, perhaps it belongs at the head of the line?” he wrote. “Should we offer it to all patients failing conservative measures? Maybe, although almost certainly there will be patients and/or disease segments that do better or worse with it. What is most apparent is that clinicians need advice on what to offer these patients, and when.” – by Adam Leitenberger
Disclosures: The researchers and editorial author report no relevant financial disclosures.
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