Skip to main content
SpringerLink
Log in

Gastric per-Oral Endoscopic Myotomy for Refractory Gastroparesis: A Meta-Analysis

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

The emerging gastric per-oral endoscopic myotomy (G-POEM) is becoming an alternative treatment method for gastroparesis. This study aimed to evaluate the feasibility and safety of G-POEM for gastroparesis.

Methods

Relevant publications were identified through searching PubMed, EMBASE, Cochrane Library, and Web of Science before April 1, 2019. Studies presenting the clinical data of G-POEM for the treatment of gastroparesis were included. Data about effectiveness and safety were extracted, pooled, and analyzed. Forest plots were graphed based on random effects models.

Results

A total of 272 patients representing 8 studies were eligible for analysis. The pooled rates of GCSI at preprocedure, 1–3 months, 6 months, and 12 months, were 3.25 (95% CI, 2.75–3.75), 1.80 (95% CI, 1.10–2.49), 1.56 (95% CI, 0.45–2.68), and 1.10 (95% CI, 0.75–1.45), respectively. The pooled results of 4-h GES pre- and post-G-POEM were 41.89% (95% CI, 32.75–51.03%) and 16.48% (95% CI, 9.83–23.14%), respectively. Furthermore, the pooled clinical response rate was 84% (95% CI, 77–89%). The GES improvement rate and GES normal rate were also analyzed, and the results were 84% (95% CI, 77–90%) and 53% (95% CI, 39–66%), respectively. Finally, the pooled adverse events rate was 12% (95% CI, 6–19%).

Conclusions

G-POEM was shown to be feasible and safe for the treatment of gastroparesis with various etiologies, which could be a potential first-line therapy for certain patients. Future studies are needed to investigate the appropriate patients for G-POEM to explore the “most beneficial” subgroup of patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Jung HK, Choung RS, Locke GR, 3rdet al. . The incidence, prevalence, and outcomes of patients with gastroparesis in Olmsted County, Minnesota, from 1996 to 2006 Gastroenterology. 2009;136:1225–1233.

  2. Wang YR, Fisher RS, Parkman HP. Gastroparesis-related hospitalizations in the United States: trends, characteristics, and outcomes, 1995-2004 The American journal of gastroenterology. 2008;103:313-322; Wadhwa V, Mehta D, Jobanputra Y, Lopez R, Thota PN, Sanaka MR. Healthcare utilization and costs associated with gastroparesis World journal of gastroenterology. 2017;23:4428–4436.

  3. Mearin F, Camilleri M, Malagelada JR. Pyloric dysfunction in diabetics with recurrent nausea and vomiting Gastroenterology. 1986;90:1919–1925; Soykan I, Sivri B, Sarosiek I, Kiernan B, McCallum RW. Demography, clinical characteristics, psychological and abuse profiles, treatment, and long-term follow-up of patients with gastroparesis Digestive diseases and sciences. 1998;43:2398–2404.

  4. Rao AS, Camilleri M. Review article: metoclopramide and tardive dyskinesia Alimentary pharmacology & therapeutics. 2010;31:11–19.

  5. Bromer MQ, Friedenberg F, Miller LS, Fisher RS, Swartz K, Parkman HP. Endoscopic pyloric injection of botulinum toxin A for the treatment of refractory gastroparesis Gastrointestinal endoscopy. 2005;61:833–839.

  6. Hejazi RA, McCallum RW. Treatment of refractory gastroparesis: gastric and jejunal tubes, botox, gastric electrical stimulation, and surgery Gastrointestinal endoscopy clinics of North America. 2009;19:73–82, vi.

  7. Lal N, Livemore S, Dunne D, Khan I. Gastric Electrical Stimulation with the Enterra System: A Systematic Review Gastroenterology research and practice. 2015;2015:762972.

  8. Hibbard ML, Dunst CM, Swanstrom LL. Laparoscopic and endoscopic pyloroplasty for gastroparesis results in sustained symptom improvement Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 2011;15:1513–1519.

  9. Jones MP, Maganti K. A systematic review of surgical therapy for gastroparesis The American journal of gastroenterology. 2003;98:2122–2129.

  10. Arts J, Holvoet L, Caenepeel Pet al. . Clinical trial: a randomized-controlled crossover study of intrapyloric injection of botulinum toxin in gastroparesis Alimentary pharmacology & therapeutics. 2007;26:1251–1258; Friedenberg FK, Palit A, Parkman HP, Hanlon A, Nelson DB. Botulinum toxin A for the treatment of delayed gastric emptying The American journal of gastroenterology. 2008;103:416–423.

  11. Tokura Y, Khashab MA, Besharati Set al. . Refractory gastroparesis can be successfully managed with endoscopic transpyloric stent placement and fixation (with video) The Journal of dermatology. 2015;82:1106–1109; Aoshima M, Suzuki Y, Masuda Y, Yoshinari Y, Hashizume H. Successful treatment of chronic intractable pain with risperidone in a patient with acquired idiopathic generalized anhidrosis. 2018;45:e189-e190.

  12. O'Grady G, Egbuji JU, Du P, Cheng LK, Pullan AJ, Windsor JA. High-frequency gastric electrical stimulation for the treatment of gastroparesis: a meta-analysis World journal of surgery. 2009;33:1693-1701; Levinthal DJ, Bielefeldt K. Systematic review and meta-analysis: Gastric electrical stimulation for gastroparesis Autonomic neuroscience : basic & clinical. 2017;202:45–55.

  13. Bhayani NH, Sharata AM, Dunst CM, Kurian AA, Reavis KM, Swanstrom LL. End of the road for a dysfunctional end organ: laparoscopic gastrectomy for refractory gastroparesis Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 2015;19:411–417.

  14. Mekaroonkamol P, Dacha S, Patel Vet al. . Outcomes of Per Oral Endoscopic Pyloromyotomy in the United States Gastrointestinal endoscopy clinics of North America. 2019;29:151–160.

  15. Lebares C, Swanstrom LL. Per-Oral Pyloromyotomy (POP): An Emerging Application of Submucosal Tunneling for the Treatment of Refractory Gastroparesis Gastrointestinal endoscopy clinics of North America. 2016;26:257–270.

    Article  Google Scholar 

  16. Khashab MA, Stein E, Clarke JOet al. . Gastric peroral endoscopic myotomy for refractory gastroparesis: first human endoscopic pyloromyotomy (with video) Gastrointestinal endoscopy. 2013;78:764–768.

  17. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses European journal of epidemiology. 2010;25:603–605.

  18. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses BMJ (Clinical research ed.). 2003;327:557–560.

  19. Xue HB, Fan HZ, Meng XMet al. . Fluoroscopy-guided gastric peroral endoscopic pyloromyotomy (G-POEM): a more reliable and efficient method for treatment of refractory gastroparesis Surgical endoscopy. 2017;31:4617–4624; Koul A, Dacha S, Mekaroonkamol Pet al. . Fluoroscopic gastric peroral endoscopic pyloromyotomy (G-POEM) in patients with a failed gastric electrical stimulator Gastroenterology report. 2018;6:122–126.

  20. Gonzalez JM, Lestelle V, Benezech Aet al. . Gastric per-oral endoscopic myotomy with antropyloromyotomy in the treatment of refractory gastroparesis: clinical experience with follow-up and scintigraphic evaluation (with video) Gastrointestinal endoscopy. 2017;85:132–139; Mekaroonkamol P, Dacha S, Wang Let al. . Gastric Peroral Endoscopic Pyloromyotomy Reduces Symptoms, Increases Quality of Life, and Reduces Health Care Use For Patients With Gastroparesis Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2019;17:82–89; Allemang MT, Strong AT, Haskins IN, Rodriguez J, Ponsky JL, Kroh M. How I Do It: Per-Oral Pyloromyotomy (POP) Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 2017;21:1963–1968; Dacha S, Mekaroonkamol P, Li Let al. . Outcomes and quality-of-life assessment after gastric per-oral endoscopic pyloromyotomy (with video) Gastrointestinal endoscopy. 2017;86:282–289; Strong AT, Landreneau JP, Cline Met al. . Per-Oral Pyloromyotomy (POP) for Medically Refractory Post-Surgical Gastroparesis Journal of Gastrointestinal Surgery. 2019.

  21. Rodriguez JH, Haskins IN, Strong ATet al. . Per oral endoscopic pyloromyotomy for refractory gastroparesis: initial results from a single institution Surgical endoscopy. 2017;31:5381–5388.

  22. Landreneau JP, Strong AT, El-Hayek Ket al. . Laparoscopic pyloroplasty versus endoscopic per-oral pyloromyotomy for the treatment of gastroparesis Surgical endoscopy. 2019;33:773–781.

  23. Shlomovitz E, Pescarus R, Cassera MAet al. . Early human experience with per-oral endoscopic pyloromyotomy (POP) Surgical endoscopy. 2015;29:543–551.

  24. Gonzalez JM, Benezech A, Vitton V, Barthet M. G-POEM with antro-pyloromyotomy for the treatment of refractory gastroparesis: mid-term follow-up and factors predicting outcome Alimentary pharmacology & therapeutics. 2017;46:364–370.

  25. Khashab MA, Ngamruengphong S, Carr-Locke Det al. . Gastric per-oral endoscopic myotomy for refractory gastroparesis: results from the first multicenter study on endoscopic pyloromyotomy (with video) Gastrointestinal endoscopy. 2017;85:123–128.

  26. Kahaleh M, Gonzalez JM, Xu MMet al. . Gastric peroral endoscopic myotomy for the treatment of refractory gastroparesis: a multicenter international experience Endoscopy. 2018;50:1053–1058.

  27. Malik Z, Kataria R, Modayil Ret al. . Gastric Per Oral Endoscopic Myotomy (G-POEM) for the Treatment of Refractory Gastroparesis: Early Experience Digestive diseases and sciences. 2018;63:2405–2412.

  28. Rodriguez J, Strong AT, Haskins INet al. . Per-oral Pyloromyotomy (POP) for Medically Refractory Gastroparesis: Short Term Results From the First 100 Patients at a High Volume Center Annals of surgery. 2018;268:421–430.

  29. Jacques J, Pagnon L, Hure Fet al. . Peroral endoscopic pyloromyotomy is efficacious and safe for refractory gastroparesis: prospective trial with assessment of pyloric function Endoscopy. 2019;51:40–49.

  30. Mekaroonkamol P, Patel V, Shah Ret al. . Association between duration or etiology of gastroparesis and clinical response after gastric per-oral endoscopic pyloromyotomy Gastrointestinal endoscopy. 2019;89:969–976.

  31. Kawai M, Peretta S, Burckhardt O, Dallemagne B, Marescaux J, Tanigawa N. Endoscopic pyloromyotomy: a new concept of minimally invasive surgery for pyloric stenosis Endoscopy. 2012;44:169–173.

  32. Soares RV, Swanstrom LL. Endoscopic approaches to gastroparesis Current opinion in gastroenterology. 2015;31:368–373.

Download references

Acknowledgments

Special thanks to Dr. Bin Ma for his selfless teaching and help for Dr. Peiwen Li to conduct this study.

Funding

This study was supported by the Natural Science Foundation of Liaoning Province (Grant No. 2015020561), the Fund for Scientific Research of The First Hospital of China Medical University (Grant No. fsfh1514) and Wu Jieping Medical Foundation (Grant No. 320.6750.18293).

Author information

Authors and Affiliations

  1. Department of Thoracic Surgery, The First Hospital of China Medical University, No.155 North Nanjing Street, Shenyang, 110001, People’s Republic of China

    Peiwen Li, Shulei Gong, Xinyu Zhang & Wenya Li

  2. Department of Colorectal Surgery, Liaoning Cancer Hospital and Institute, Cancer Hospital of China Medical University, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, People’s Republic of China

    Bin Ma

Authors
  1. Peiwen Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bin Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shulei Gong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xinyu Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wenya Li
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wenya Li.

Ethics declarations

Conflict of Interest

Dr. Peiwen Li, Dr. Bin Ma, Dr. Shulei Gong, Dr. Xinyu Zhang, and Dr. Wenya Li have no conflicts of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, P., Ma, B., Gong, S. et al. Gastric per-Oral Endoscopic Myotomy for Refractory Gastroparesis: A Meta-Analysis. J Gastrointest Surg 25, 1108–1116 (2021). https://doi.org/10.1007/s11605-020-04520-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-020-04520-x

Keywords

Search

Navigation