Systematic review with meta‐analysis: one‐year outcomes of gastric peroral endoscopic myotomy for refractory gastroparesis

Kamal, Faisal; Khan, Muhammad Ali; Lee‐Smith, Wade; Sharma, Sachit; Acharya, Ashu; Jowhar, Dawit; Farooq, Umer; Aziz, Muhammad; Kouanda, Abdul; Dai, Sun-Chuan; Howden, Colin W.; Munroe, Craig A.

doi:10.1111/apt.16725

Cited by 29 publications

(34 citation statements)

References 37 publications

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“…Long‐term efficacy beyond 12 months ranged from 53% to 70% of patients in retrospective studies, 75,77,91 and 33% to 56% in prospective trials, 89,92,93 based on GCSI variation. A recent meta‐analysis involving 10 studies and 482 patients calculated a pooled success rate of 61% at 1 year 94 . Longer‐term data were reported in a study by Tan, with a sustained efficacy in only 33% of patients at 2 years, whereas Ragi et al reported a sustained efficacy of 74% at 24 months 75 .…”

Section: Efficacy and Safety Of G‐poemmentioning

confidence: 99%

Targeting the pylorus in gastroparesis: From physiology to endoscopic pyloromyotomy

Soliman

Gourcerol

2023

Neurogastroenterology Motil

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Gastroparesis is defined as delayed gastric emptying (GE) of solid food in the absence of mechanical obstruction. 1 Cardinal symptoms include nausea, vomiting, gastric fullness, early satiety, bloating, and abdominal pain/discomfort. 2 These symptoms can overlap with those of functional dyspepsia, but gastroparesis has to be confirmed by an objective measurement of GE, either by scintigraphy, or by 13 Coctanoic acid breath test. The prevalence of diagnosed gastroparesis has been evaluated in the United States at 0.24% of the population. 3 Recent epidemiological data from the United Kingdom confirm a similar prevalence of 0.13% in Europe based on the diagnostic code, although the disease appears to be underdiagnosed. 4 Gastroparesis leads to an economic burden, evaluated between US$4000 and US$9000 per patient per year in a recent study. 5 Moreover, delayed GE has been associated with increased mortality, independently of age, sex, or the etiology of the disease. 6 The first-line treatment relies on dietary modification and medical treatment, with prokinetic drugs such as metoclopramide. 7,8 However, the efficacy of medical treatment is limited, and up to 40% of patients are considered to be refractory after appropriate treatment. 9 Severe refractory gastroparesis can lead to dehydration, weight loss, and impaired quality of life and could become a challenging condition. 10 Thus, invasive techniques have been developed to improve the symptoms of such patients.Considering the role of pyloric dysfunction in gastroparesis, 11 gastric peroral endoscopic pyloromyotomy (G-POEM) has emerged as an alternative therapeutic technique in patients with refractory gastroparesis. The first human case was described in 2013 by Khashab et al. 12 The technique is based on the principles of peroral endoscopic myotomy of the lower esophageal sphincter, used to treat achalasia. Since then, cohort studies have assessed the clinical efficacy and the safety of G-POEM in refractory gastroparesis.This review aims to detail the role of the pylorus in the pathophysiology of gastroparesis, and then to report the efficacy, modalities, and the place of G-POEM, based on the results of published studies.

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Section: Efficacy and Safety Of G‐poemmentioning

confidence: 99%

Targeting the pylorus in gastroparesis: From physiology to endoscopic pyloromyotomy

Soliman

Gourcerol

2023

Neurogastroenterology Motil

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“…Gastric per-oral endoscopic myotomy (G-POEM) is an offshoot of POEM that permits endoscopic pyloromyotomy. The procedure was first described by Khashab et al in 2013 and >1,000 cases have been reported since then [ 56 ].…”

Section: Gastric Poemmentioning

confidence: 99%

“…Multiple observational studies have been published on G-POEM since its introduction into clinical practice in 2013. Kamal et al recently performed a systematic review and meta-analysis of 10 studies (482 patients) evaluating the efficacy of G-POEM in refractory gastroparesis with at least 1 year of follow-up [ 56 ]. The pooled rates (95% confidence interval) of clinical success at 1 year and adverse events were 61% (49%–71%) and 8% (6%–11%), respectively.…”

Section: Gastric Poemmentioning

confidence: 99%

Third-space endoscopy: the final frontier

Hayat

Yang

Draganov

2022

Gastroenterology Report

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Over the years, our growing experience with endoscopic submucosal dissection along with technological advances has solidified our comfort and knowledge on working in the submucosa, also referred to as the “third space.” Per-oral endoscopic myotomy (POEM) was the first prototype third-space endoscopy (TSE) procedure, demonstrating the feasibility and clinical utility of endoscopic esophagogastric myotomy via submucosal tunneling. The launch of POEM accelerated the evolution of TSE from a vanguard concept to an expanding field with a wide range of clinical applications. In this review, we discuss the status and future directions of multiple TSE interventions.

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“…[ 7 ] Similarly, Kamal et al showed reduction of GCSI by -1.4 (CI: -1.9 -0.9) at 1 year follow-up. [ 8 ] Neither of these meta-analyses compared G-POEM to surgical approach.…”

Section: Introductionmentioning

confidence: 99%

Gastric peroral endoscopic myotomy versus surgical pyloromyotomy/pyloroplasty for refractory gastroparesis: systematic review and meta-analysis

et al. 2022

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Background and Study Aim Gastric per-oral endoscopic myotomy (G-POEM) has been recently compared with surgical techniques (i.e. pyloromyotomy and pyloroplasty) for managing patients with refractory gastroparesis. Given the varying results, we performed a systematic review and meta-analysis of available studies to assess the safety and efficacy of each technique. Patients and Methods A comprehensive review of the literature using the following databases was undertaken through July 29th, 2022: MEDLINE, Embase, Web of Science, KCI – Koran Journal index, Global Index Medicus, and Cochrane. Comparative studies including case-control, cohort and randomized controlled trials (RCTs) were included. Random effects model using DerSimonian laird approach was used to compare outcomes. Relative risk (RR) and mean difference (MD) were calculated for binary and continuous outcomes respectively. Results A total of 4 studies with 385 patients (216 in the G-POEM group and 169 in the surgical group were included. The mean age was 46.9 (±3.41) and 46.2 (±0.86) and the female proportion was 79.6% and 74.0% for the G-POEM and surgery group respectively. The mean procedural time (MD: -59.47 mins, p<0.001) and length of hospital stay (MD: -3.10 days, p<0.001) was significantly lower for G-POEM compared to surgery. The post procedure GCSI score (MD: -0.33, p=0.39) and reduction in GCSI score pre- and post-operatively (MD: 0.27, p=0.55) was not significantly different. Conclusion G-POEM appears promising as it can provide a cost-effective approach for managing refractory gastroparesis compared to surgical techniques. RCTs are needed to further confirm these results.

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Systematic review with meta‐analysis: one‐year outcomes of gastric peroral endoscopic myotomy for refractory gastroparesis

Cited by 29 publications

References 37 publications

Targeting the pylorus in gastroparesis: From physiology to endoscopic pyloromyotomy

Targeting the pylorus in gastroparesis: From physiology to endoscopic pyloromyotomy

Third-space endoscopy: the final frontier

Gastric peroral endoscopic myotomy versus surgical pyloromyotomy/pyloroplasty for refractory gastroparesis: systematic review and meta-analysis

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