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Disease duration predicts response to GPOEM for gastroparesis
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WASHINGTON — Investigators found that shorter disease duration was the key predictor of response to gastric per oral endoscopic pyloromyotomy for gastroparesis, a presenter said.
In contrast, the etiology of gastroparesis was not predictive of successful treatment with GPOEM.
“The aim of this study was to evaluate the safety and efficacy of GPOEM and compare clinical outcomes between diabetic and non-diabetic cohorts, and to identify predictive factors of clinical response to the procedure,” Parit Mekaroonkamol, MD, of Emory University, said during his presentation.
In this single-center study, he and colleagues reviewed longitudinal data on 25 patients with non-diabetic gastroparesis and 15 with diabetic gastroparesis. They assessed data at baseline and at 1, 6, 12 and 18 months.
Patients showed statistically significant symptom improvements throughout the study period (P = .001), and at all time points except the 1-year mark. Further, gastric emptying scintigraphy (GES) showed gastric retention dropped by 41.7% from baseline at 2 months (P < .00001).
While etiology of gastroparesis showed no association with clinical improvement, duration of disease and reduced symptoms at 12 months were significant predictors (P = .02). Longer duration of symptoms was significantly associated with poorer response to GPOEM.
The nausea and vomiting subscale showed sustained improvement throughout the study (P < .00001), but early satiety decreased significantly only at 1 and 6 months (P = .001 and P = .002). The bloating subscale did not improve significantly.
Mekaroonkamol noted that three adverse events occurred (7.5%): a capnoperitoneum, an exacerbation of COPD and a myotomy dehiscence.
He concluded that “GPOEM is a safe and efficacious therapy for refractory gastroparesis, especially for those with predominant nausea/vomiting and short duration of disease.”
Based on these findings, he and colleagues recommended that GPOEM clinical criteria should include a gastroparesis cardinal symptom index (GCSI) score of at least 2 and a gastric retention rate higher than 20% on GES. – by Adam Leitenberger
Reference:
Mekaroonkamol P, et al. Abstract 70. Presented at: Digestive Disease Week; June 2-5, 2018; Washington, D.C.
Disclosures: Mekaroonkamol reports no relevant financial disclosures. Please see the DDW faculty disclosure index for a list of all other authors’ relevant financial disclosures.
Perspective
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John R. Saltzman, MD, FACP, FACG, FASGE, AGAF
GPOEM is an exciting new area of endoscopy and an extension of submucosal endoscopy. It is part of the wider experience that physicians are starting to have performing esophageal POEM for achalasia. As this technique develops, it makes sense to expand it to other areas.
Gastroparesis is a disorder with multiple etiologies that all lead disordered emptying. It does not intuitively make sense that one treatment would be effective in all etiologies or all durations. These investigators have been leaders in terms of developing methodology and technique in performing GPOEM, but now the challenge is to determine which patients are most likely to benefit from the procedure. The authors studied underlying disease – such as having diabetes or not having diabetes – and found no significant difference in outcome. An interesting finding of this research is that disease duration appears to be a significant factor. This makes sense because the longer someone has gastroparesis, the more likely there are other manifestations such as altered gastric accommodation and contraction. In time, these manifestations may lead to a more generalized disorder of the stomach and rectifying just one aspect of the condition (pyloric myotomy) may not ultimately give a good clinical outcome.
These researchers are pioneers in developing the technique and doing great work, but the challenge now is to select patients with gastroparesis who will most likely benefit from GPOEM by determining the predictors of success.
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