One-year results of per-oral pyloromyotomy for refractory gastroparesis: a multicenter study.

Introduction Data on the long-term outcomes of gastric per-oral endoscopic myotomy (G-POEM) for refractory gastroparesis are lacking. We report the results of a large multicentre long-term follow-up study of G-POEM for refractory gastroparesis. Materials and methods This was a retrospective, multicentre study of all G-POEM operations performed in seven expert French centres for refractory gastroparesis with at least 1 year of follow-up. The primary endpoint was the 1-year clinical success rate, defined as an at least one-point improvement in the Gastroparesis Cardinal Symptom Index (GCSI). Results Seventy-six patients were included (Women: 60.5%; Age: 56 years). The median symptom duration was 48 months. The median gastric retention at 4 h (H4) before G-POEM was 45% [IQR: 29; 67]. The median GCSI before G-POEM was 3.6 [IQR: 2.8; 4]. Clinical success was achieved in 71.4% of the patients at 1 year, with a median rate of reduction in the GCSI score of 41%. In logistic regression analysis, only a high preoperative GCSI satiety subscale was predictive of clinical success (OR = 3.41 (CI95% 1.01-11.54), p = 0.048), while a high rate of gastric retention at H4 was significantly associated with clinical failure (OR = 0.97 (CI95% 0.95-1.00), p = 0.032). Conclusions The results confirm the efficacy of G-POEM for the treatment of refractory gastroparesis, as evidenced by a 71.4% clinical success rate at 1 year. G-POEM is promising, prospective sham-controlled trials are urgently needed to confirm its efficacy and identify the patient populations who will benefit most from this procedure.