P2725 - Meta-Analysis on Gastric Per-Oral Endoscopic Myotomy as an Emerging Technique for Refractory Gastroparesis

Vishal Chandel, MD¹, Neel Chandel, MD², Robin Zachariah, MD³, Emad Mansoor, MD⁴, Zubair Malik, MD⁵, Henry Parkman, MD^5
1Suburban Community Hospital, Feasterville-Trevose, PA; ²St. Mary Medical Center, Feasterville-tTevose, PA; ³Duke University Hospital, Durham, NC; ⁴Case Western Reserve University / University Hospitals, Cleveland, OH; ⁵Temple University Hospital, Philadelphia, PA

Introduction: Symptoms of Refractory Gastroparesis (RG) don’t respond adequately to treatment, due to complex pathophysiology and limited therapeutic options. Gastric per-oral endoscopic myotomy (GPOEM) is a promising novel technique for the treatment of RG with encouraging short-term efficacy rate of 80%. Our aim from this meta-analysis is to evaluate for any differences in outcomes and safety of G-POEM for RG.

Methods: We used PubMed, Medline & EMBASE before 7/1/2022, for relevant publications. Only studies presenting the clinical outcome’s data of G-POEM for gastroparesis were included. Studies without data of gastroparesis cardinal symptom index (GCSI) pre- and post-procedure, data of gastric emptying scintigraphy (GES) pre- and post-procedure were excluded. Meta-analysis was done by the RevMan (Review Manager) 5.3.

Results: We included 29 studies with a total of 1349 patients who underwent GPOEM. Clinical success rate in all 29 studies was 75.3%, while technical success rate was 100% and mean follow-up duration was 11.59 months. Pre and Post GPOEM GCSI, GES, and sub-scores were compared. Meta analysis for GCSI included 26 studies pre-GPOEM, 9 studies from 1 month, 12 studies from 3 months, 10 from 6 months, 12 from 12 months, 2 studies each from 18 and 24 months, 1 study each from 36 and 48 months respectively. The pooled mean difference (MD) in GCSI with a 95% of confidence interval with MD was 1.84[1.57, 2.11] by Cochran Q test (p< 0.001, I² =81%) for 1 month, 1.71[1.41, 2.02] with (p< 0.001, I² = 78%) for 3 month, 1.91[1.65, 2.18] with (p< 0.001, I² =86%) for 6 months, 1.78[1.51, 2.06] with (p< 0.001, I² =88%) for 12 months, 1.74[1.56, 1.92] with (p< 0.001) for 18 months, 2.08[1.93, 2.23] with (p< 0.001) for 24 months, 2.70 [2.42, 2.98] with (p< 0.001) for 36 months and 1.74 [1.65, 1.83] with (p< 0.001) for 48 months. There was remarkable reduction in GCSI score with an overall effect size (Z) of 33.60 (p< 0.00001) and a combined MD of 1.84 [1.73,1.95]. However, significant heterogeneity was observed among studies in GCSI; I²=87%. Gastric retention improvement was evaluated by GES as well. There was a statistically significant difference between the pre-GPOEM and all follow-ups for both GCSI and GES.

Discussion: Our results show that GPOEM is a safe and feasible option for the treatment of RG. We need further studies, especially RCT’s, to investigate for further evaluation of our results. This meta-analysis demonstrates the efficacy of G-POEM and the clinical response outcomes are encouraging.



Disclosures:


Vishal Chandel, MD¹, Neel Chandel, MD², Robin Zachariah, MD³, Emad Mansoor, MD⁴, Zubair Malik, MD⁵, Henry Parkman, MD⁵. P2725 - Meta-Analysis on Gastric Per-Oral Endoscopic Myotomy as an Emerging Technique for Refractory Gastroparesis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.