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Efficacy and safety of gastric per-oral endoscopic myotomy (GPOEM) in lung transplant patients with refractory gastroparesis: a systematic review and meta-analysis

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Abstract

Background

Post-lung transplant gastroparesis is a frequent debilitating complication of lung transplant recipients, as it can increase the risk for gastro-esophageal reflux disease and subsequent graft dysfunction. We performed a systematic review and meta-analysis to evaluate the efficacy and safety of GPOEM in lung transplant patients with refractory gastroparesis.

Methods

The present systematic review and meta-analysis wer performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. We selected studies that analyzed the gastroparesis cardinal symptom index (GCSI) before and after the procedure to verify the efficacy of GPOEM. Random-effects model was used and the analysis was performed with STATA 17.

Results

Four observational studies (one conference abstract) with 104 patients were included in the meta-analysis. Prior treatments for gastroparesis included prokinetic agents and botulinum toxin in 78% (78/104) and 66.7% (66/99), respectively. Pooled estimate for clinical efficacy of GPOEM was 83% (95% CI 76%–90%). The pooled mean reduction in GCSI following the procedure was − 2.01 (− 2.35, − 1.65, p = 0.014). Three studies reported statistically significant improvement of gastro-esophageal retention or emptying in the post-GPOEM period. 30-day post-operative complications included minor or major bleeding (11.6%), severe reflux (1.2%), and pyloric stenosis (1.2%) requiring re-intervention. 90-day all-cause mortality was 2.6% with one patient dying from severe allograft rejection.

Conclusion

Our study showed that GPOEM is an effective and safe strategy for lung transplant patients with refractory gastroparesis and should be considered as a therapeutic strategy in this population. Larger multicenter trials are needed in the future to further evaluate the effect of GPOEM on allograft function and rates of rejection.

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Funding

This research received no specific grant support from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Medicine, MedStar Washington Hospital Center, Washington, DC, USA

    Spyros Peppas, Akram I. Ahmad & Nadera Altork

  2. Georgetown University School of Medicine, Washington, DC, USA

    Won Kyoo Cho

  3. Division of Gastroenterology/Hepatology, INOVA Health System Leesburg, Leesburg, VA, USA

    Won Kyoo Cho

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Correspondence to Spyros Peppas.

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Dr. Spyridon Peppas, Dr. Akram I Ahmad, Dr. Nadera Altork, and Dr. Won Kyoo Cho have no conflict of interest to disclose.

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Peppas, S., Ahmad, A.I., Altork, N. et al. Efficacy and safety of gastric per-oral endoscopic myotomy (GPOEM) in lung transplant patients with refractory gastroparesis: a systematic review and meta-analysis. Surg Endosc 37, 6695–6703 (2023). https://doi.org/10.1007/s00464-023-10287-4

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