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CC BY 4.0 · Journal of Digestive Endoscopy
DOI: 10.1055/s-0045-1811190
Review Article

Breaking the Gastroparesis Bottleneck: Gastric Peroral Endoscopic Myotomy versus Pyloroplasty—a Narrative Review

Zubin Sharma 
1   Department of Digestive and Hepatobiliary Sciences, Fortis Memorial Research Institute, Gurugram, Haryana, India
,
Shubham Sisodia
1   Department of Digestive and Hepatobiliary Sciences, Fortis Memorial Research Institute, Gurugram, Haryana, India
,
Neha Choudhary
1   Department of Digestive and Hepatobiliary Sciences, Fortis Memorial Research Institute, Gurugram, Haryana, India
,
Bansal Rinkesh
1   Department of Digestive and Hepatobiliary Sciences, Fortis Memorial Research Institute, Gurugram, Haryana, India
,
Gourdas Choudhuri
1   Department of Digestive and Hepatobiliary Sciences, Fortis Memorial Research Institute, Gurugram, Haryana, India
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Funding None.
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Abstract

Gastroparesis is a chronic gastric motility disorder characterized by delayed gastric emptying and debilitating symptoms. In refractory cases, interventions targeting the pylorus (gastric peroral endoscopic myotomy [G-POEM] and surgical pyloroplasty) have emerged as effective therapeutic options. This narrative review compares the efficacy, safety, durability, and cost-effectiveness of G-POEM and pyloroplasty in adult patients with medically refractory gastroparesis.

Both G-POEM and pyloroplasty demonstrate comparable clinical efficacy, with 70 to 80% of patients achieving symptom improvement and enhanced gastric emptying, irrespective of underlying etiology (idiopathic, diabetic, or post-surgical). G-POEM offers advantages in procedural time, recovery, complication rates, and cost, while surgical pyloroplasty shows marginally superior improvements in objective gastric emptying in select cohorts. Long-term durability is comparable, though symptom recurrence may affect up to 30 to 50% by 5 years. G-POEM is repeatable and preserves future surgical options, whereas surgical pyloroplasty remains a definitive intervention.

Both G-POEM and pyloroplasty are effective, safe, and durable interventions for refractory gastroparesis. G-POEM offers a minimally invasive, cost-effective alternative with similar efficacy, making it a preferred first-line intervention in appropriately selected patients. Individualized therapy based on anatomy, expertise, and patient preference is key to optimizing outcomes.

Keywords

gastroparesis - G-POEM - pyloroplasty - myotomy - gastric motility - GCSI

Authors' Contributions

Z.S.: conception of the idea, preparation of manuscript, review of the final draft, and approval.


S.S.: preparation of manuscript, editing of the draft, and final approval


N.C.: preparation of manuscript, editing the draft, and final approval


B.R.: preparation of manuscript, editing the draft, and approval


G.C.: review of manuscript, editing the draft, and approval




Publication History

Article published online:
08 August 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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