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DOI: 10.1055/a-1111-8566
Gastric peroral endoscopic pyloromyotomy versus gastric electrical stimulation in the treatment of refractory gastroparesis: a propensity score-matched analysis of long term outcomes
Abstract
Background Gastric peroral endoscopic pyloromyotomy (G-POEM) and gastric electrical stimulation (GES) have been reported as treatment options for refractory gastroparesis. In this study, we compared the long term clinical outcomes of G-POEM versus GES in the treatment of such patients.
Methods We retrospectively evaluated 111 consecutive patients with refractory gastroparesis between January 2009 and August 2018. To overcome selection bias, we used propensity score matching (1:1) between G-POEM and GES treatment. The primary outcome was the duration of clinical response.
Results After propensity score matching, 23 patients were included in each group. After a median follow-up of 27.7 months, G-POEM had a significantly better and longer clinical response than GES (hazard ratio [HR] for clinical recurrence 0.39, 95 % confidence interval [CI] 0.16 – 0.95; P = 0.04). The median duration of response was 25.4 months (95 %CI 8.7 – 42.0) in the GES group and was not reached in the G-POEM group. The Kaplan – Meier estimate of 24-month clinical response rate was 76.6 % with G-POEM vs. 53.7 % with GES. GES appeared to have little effect on idiopathic gastroparesis (HR for recurrence with G-POEM vs. GES 0.35, 95 %CI 0.13 – 0.95; P = 0.05). The incidence of adverse events was higher in the GES group (26.1 % vs. 4.3 %; P = 0.10).
Conclusion Among patients with refractory gastroparesis, clinical response was better and lasted longer with G-POEM than with GES. The positive outcomes with G-POEM are likely to derive from the superior clinical response in patients with idiopathic gastroparesis. Further studies are needed to confirm these findings.
* These authors contributed equally to this work.
Publication History
Received: 11 June 2019
Accepted: 15 January 2020
Article published online:
21 February 2020
© Georg Thieme Verlag KG
Stuttgart · New York
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References
- 1 Pasricha PJ, Yates KP, Nguyen L. et al. Outcomes and factors associated with reduced symptoms in patients with gastroparesis. Gastroenterology 2015; 149: 1762-1774
- 2 Heckert J, Sankineni A, Hughes WB. et al. Gastric electric stimulation for refractory gastroparesis: a prospective analysis of 151 patients at a single center. Dig Dis Sci 2016; 61: 168-175
- 3 McCallum RW, Lin Z, Forster J. et al. Gastric electrical stimulation improves outcomes of patients with gastroparesis for up to 10 years. Clin Gastroenterol Hepatol 2011; 9: 314-319
- 4 Velanovich V. Quality of life and symptomatic response to gastric neurostimulation for gastroparesis. J Gastrointest Surg 2008; 12: 1656-1662
- 5 McCallum RW, Snape W, Brody F. et al. Gastric electrical stimulation with Enterra therapy improves symptoms from diabetic gastroparesis in a prospective study. Clin Gastroenterol Hepatol 2010; 8: 947-954
- 6 Shada A, Nielsen A, Marowski S. et al. Wisconsin’s Enterra therapy experience: a multi-institutional review of gastric electrical stimulation for medically refractory gastroparesis. Surgery 2018; 164: 760-765
- 7 Lin Z, Forster J, Sarosiek I. et al. Treatment of diabetic gastroparesis by high-frequency gastric electrical stimulation. Diabetes Care 2004; 27: 1071-1076
- 8 Mekaroonkamol P, Dacha S, Wang L. et al. Gastric peroral endoscopic pyloromyotomy reduces symptoms, increases quality of life, and reduces health care use for patients with gastroparesis. Clin Gastroenterol Hepatol 2019; 17: 82-89
- 9 Xu J, Chen T, Elkholy S. et al. Gastric peroral endoscopic myotomy (G-POEM) as a treatment for refractory gastroparesis: long-term outcomes. Can J Gastroenterol Hepatol 2018; 2018: 6409698
- 10 Kahaleh M, Gonzalez JM, Xu MM. et al. Gastric peroral endoscopic myotomy for the treatment of refractory gastroparesis: a multicenter international experience. Endoscopy 2018; 50: 1053-1058
- 11 Koul A, Dacha S, Mekaroonkamol P. et al. Fluoroscopic gastric peroral endoscopic pyloromyotomy (G-POEM) in patients with a failed gastric electrical stimulator. Gastroenterol Rep (Oxf) 2018; 6: 122-126
- 12 Camilleri M, Parkman HP, Shafi MA. et al. Clinical guideline: management of gastroparesis. Am J Gastroenterol 2013; 108: 18-37
- 13 Abell TL, Camilleri M, Donohoe K. et al. Consensus recommendations for gastric emptying scintigraphy: a joint report of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine. Am J Gastroenterol 2008; 103: 753-763
- 14 Dacha S, Mekaroonkamol P, Li L. et al. Outcomes and quality-of-life assessment after gastric per-oral endoscopic pyloromyotomy (with video). Gastrointest Endosc 2017; 86: 282-289
- 15 Li L, Spandorfer R, Qu C. et al. Gastric per-oral endoscopic myotomy for refractory gastroparesis: a detailed description of the procedure, our experience, and review of the literature. Surg Endosc 2018; 32: 3421-3431
- 16 Forster J, Sarosiek I, Delcore R. et al. Gastric pacing is a new surgical treatment for gastroparesis. Am J Surg 2001; 182: 676-681
- 17 Mekaroonkamol P, Patel V, Shah R. et al. Association between duration or etiology of gastroparesis and clinical response after gastric per-oral endoscopic pyloromyotomy. Gastrointest Endosc 2019; 89: 969-976
- 18 Gonzalez JM, Benezech A, Vitton V. et al. G-POEM with antro-pyloromyotomy for the treatment of refractory gastroparesis: mid-term follow-up and factors predicting outcome. Aliment Pharmacol Ther 2017; 46: 364-370
- 19 Khashab MA, Ngamruengphong S, Carr-Locke D. et al. Gastric per-oral endoscopic myotomy for refractory gastroparesis: results from the first multicenter study on endoscopic pyloromyotomy (with video). Gastrointest Endosc 2017; 85: 123-128
- 20 Rodriguez J, Strong AT, Haskins IN. et al. Per-oral pyloromyotomy (POP) for medically refractory gastroparesis: short term results from the first 100 patients at a high volume center. Ann Surg 2018; 268: 421-430
- 21 Gonzalez JM, Lestelle V, Benezech A. et al. Gastric per-oral endoscopic myotomy with antropyloromyotomy in the treatment of refractory gastroparesis: clinical experience with follow-up and scintigraphic evaluation (with video). Gastrointest Endosc 2017; 85: 132-139
- 22 Shlomovitz E, Pescarus R, Cassera MA. et al. Early human experience with per-oral endoscopic pyloromyotomy (POP). Surg Endosc 2015; 29: 543-551
- 23 Rodriguez JH, Haskins IN, Strong AT. et al. Per oral endoscopic pyloromyotomy for refractory gastroparesis: initial results from a single institution. Surg Endosc 2017; 31: 5381-5388
- 24 Camilleri M, Bharucha AE, Farrugia G. Epidemiology, mechanisms, and management of diabetic gastroparesis. Clin Gastroenterol Hepatol 2011; 9: 5-12
- 25 Camilleri M, Chedid V, Ford AC. et al. Gastroparesis. Nat Rev Dis Primers 2018; 4: 41
- 26 Hibbard ML, Dunst CM, Swanstrom LL. Laparoscopic and endoscopic pyloroplasty for gastroparesis results in sustained symptom improvement. J Gastrointest Surg 2011; 15: 1513-1519
- 27 Landreneau JP, Strong AT, El-Hayek K. et al. Laparoscopic pyloroplasty versus endoscopic per-oral pyloromyotomy for the treatment of gastroparesis. Surg Endosc 2019; 33: 773-781
- 28 Lin Z, Hou Q, Sarosiek I. et al. Association between changes in symptoms and gastric emptying in gastroparetic patients treated with gastric electrical stimulation. Neurogastroenterol Motil 2008; 20: 464-470
- 29 Moraveji S, Bashashati M, Elhanafi S. et al. Depleted interstitial cells of Cajal and fibrosis in the pylorus: novel features of gastroparesis. Neurogastroenterol Motil 2016; 28: 1048-1054
- 30 Farrugia G. Histologic changes in diabetic gastroparesis. Gastroenterol Clin North Am 2015; 44: 31-38
- 31 Chu H, Lin Z, Zhong L. et al. Treatment of high-frequency gastric electrical stimulation for gastroparesis. J Gastroenterol Hepatol 2012; 27: 1017-1026
- 32 Musunuru S, Beverstein G, Gould J. Preoperative predictors of significant symptomatic response after 1 year of gastric electrical stimulation for gastroparesis. World J Surg 2010; 34: 1853-1858
- 33 Filichia LA, Cendan JC. Small case series of gastric stimulation for the management of transplant-induced gastroparesis. J Surg Res 2008; 148: 90-93
- 34 Friedenberg FK, Palit A, Parkman HP. et al. Botulinum toxin A for the treatment of delayed gastric emptying. Am J Gastroenterol 2008; 103: 416-423
- 35 Arts J, Holvoet L, Caenepeel P. et al. Clinical trial: a randomized-controlled crossover study of intrapyloric injection of botulinum toxin in gastroparesis. Aliment Pharmacol Ther 2007; 26: 1251-1258