P3711 - Efficacy and Safety of Gastric Peroral Endoscopic Myotomy for Refractory Gastroparesis

Muhammad Nadeem. Yousaf, MD¹, Darian Fard, MD¹, Xheni Deda, MD¹, Karthik Gangu, MD², Moafa Ghady, MD¹, Sanket Basida, MD¹, Alexander K. Malik, MD³, Mustafa Gandhi, MD¹, Ahmed I.A. Swi, MD¹, Niraj Shah, MD¹, Ghassan M. Hammoud, MD^1
1University of Missouri-Columbia, Columbia, MO; ²Kansas University Medical Center, Kansas City, KS; ³Summa Health System, Akron, OH

Introduction: Gastric peroral endoscopic myotomy (G-POEM) is an emerging third space endoscopic technique for the management of refractory gastroparesis. We sought to determine the efficacy and safety of G-POEM for patients with refractory gastroparesis.

Methods: This is a retrospective, single-center study of consecutive patients with refractory gastroparesis who underwent G-POEM between February 2020 to September 2022. Primary outcome was clinical success defined as improvement in gastroparesis cardinal symptoms index (GCSI) score by 25% and improvement in percent of gastric emptying at 4 hours. Secondary outcomes included technical success rate (defined as successful completion of all procedural steps), rate of adverse events (AE), frequency of hospitalization due to recurrent symptoms after G-POEM and need for additional endoscopic or surgical interventions. Refractory gastroparesis was defined as persistent symptoms despite dietary modifications and pharmacologic therapy.

Results: A total of 25 patients, 18 (72%) females, mean age 58.5±14.7 year, and mean BMI 31.3±8.5 Kg/m² were included. The most common etiology of gastroparesis were idiopathic (36%), diabetes (36%), postsurgical (20%), scleroderma (4%) and marijuana use (4%). Clinical and technical success of procedure were 88% and 100% respectively. The mean duration of symptoms was 41.0±50.6 months. After G-POEM, there were significant improvement in mean GCSI score (32.8±6.8 vs 12.0±7.9, p< 0.001) and tendency of lower percentage of food retention on GES at 4 hours (46.42% vs 44.23%, p=0.3). As per the ASGE severity lexicon, peri-procedural mild AEs were seen in (8%). No patients encountered severe AEs. The common post-procedural AEs were abdominal pain (24%) and nausea (20%). The mean procedure time was 80±24 min and the mean length of hospital stay was 1.0 day. The mean length of follow-up was 7.6±6.1 months. Clinical response was not seen in 3 (12%) patients. Two patients required laparoscopic gastric stimulator placement (one patient had overlap of esophageal dysmotility, and diabetes) and another patient underwent partial gastrectomy for symptoms relief. After G-POEM, there was a significant reduction in mean emergency room visits due to gastroparesis-related symptoms (1.6±3.3 vs 0.2±0.8 (p< 0.03).

Discussion: G-POEM is feasible and effective treatment for refractory gastroparesis with a good short term clinical success rate. Predictive factors of long-term success or failure of G-POEM are yet to be explored on large multicenter studies.


Disclosures:


Muhammad Nadeem. Yousaf, MD¹, Darian Fard, MD¹, Xheni Deda, MD¹, Karthik Gangu, MD², Moafa Ghady, MD¹, Sanket Basida, MD¹, Alexander K. Malik, MD³, Mustafa Gandhi, MD¹, Ahmed I.A. Swi, MD¹, Niraj Shah, MD¹, Ghassan M. Hammoud, MD¹. P3711 - Efficacy and Safety of Gastric Peroral Endoscopic Myotomy for Refractory Gastroparesis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.