TY - JOUR
T1 - Clinical efficacy of gastric per-oral endoscopic myotomy (G-POEM) in the treatment of refractory gastroparesis and predictors of outcomes
T2 - a systematic review and meta-analysis using surgical pyloroplasty as a comparator group
AU - Mohan, Babu P.
AU - Chandan, Saurabh
AU - Jha, Lokesh K.
AU - Khan, Shahab R.
AU - Kotagiri, Rajesh
AU - Kassab, Lena L.
AU - Ravikumar, Naveen P.G.
AU - Bhogal, Neil
AU - Chandan, Ojasvini C.
AU - Bhat, Ishfaq
AU - Hewlett, Alexander T.
AU - Jacques, Jeremie
AU - Ponnada, Suresh
AU - Asokkumar, Ravishankar
AU - Adler, Douglas G.
N1 - Publisher Copyright:
© 2019, Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2020/8/1
Y1 - 2020/8/1
N2 - Background and aims: Gastric peroral endoscopic myotomy (G-POEM) is a novel minimally invasive technique in endosurgery. Data is limited as to its efficacy, safety, and predictive factors. We conducted this meta-analysis to evaluate the clinical outcomes of G-POEM and used the outcomes of surgical pyloroplasty as a comparator group in the treatment of refractory gastroparesis. Methods: We searched multiple databases from inception through March 2019 to identify studies that reported on G-POEM and pyloroplasty in gastroparesis. Our primary outcome was to analyze and compare the pooled rates of clinical success, in terms of Gastroparesis Cardinal Symptom Index (GCSI) score and 4-h gastric emptying study (GES) results, with G-POEM and pyloroplasty. Results: Three hundred and thirty-two and 375 patients underwent G-POEM (11 studies) and surgical pyloroplasty (seven studies), respectively. The pooled rate of clinical success, based on the GCSI score, with G-POEM was 75.8% (95% CI 68.1–82.1, I2 = 50) and with surgical pyloroplasty was 77.3% (95% CI 66.4–85.4, I2 = 0), with no significance, p = 0.81. The pooled rate of clinical success, based on the 4-hour GES results, with G-POEM was 85.1% (95% CI 68.9–93.7, I2 = 74) and with surgical pyloroplasty was 84% (95% CI 64.4–93.8, I2 = 81), with no significance, p = 0.91. The overall adverse events were comparable. Based on meta-regression analysis, idiopathic gastroparesis, prior treatment with botulinum toxin and gastric stimulator seemed to predict clinical success with G-POEM. Conclusion: G-POEM demonstrates clinical success in treating refractory gastroparesis. Idiopathic gastroparesis, prior treatment with botulinum injections and gastric stimulator appear to have positive predictive effects on the 4-h GES results after G-POEM. Outcomes seem comparable to surgical pyloroplasty.
AB - Background and aims: Gastric peroral endoscopic myotomy (G-POEM) is a novel minimally invasive technique in endosurgery. Data is limited as to its efficacy, safety, and predictive factors. We conducted this meta-analysis to evaluate the clinical outcomes of G-POEM and used the outcomes of surgical pyloroplasty as a comparator group in the treatment of refractory gastroparesis. Methods: We searched multiple databases from inception through March 2019 to identify studies that reported on G-POEM and pyloroplasty in gastroparesis. Our primary outcome was to analyze and compare the pooled rates of clinical success, in terms of Gastroparesis Cardinal Symptom Index (GCSI) score and 4-h gastric emptying study (GES) results, with G-POEM and pyloroplasty. Results: Three hundred and thirty-two and 375 patients underwent G-POEM (11 studies) and surgical pyloroplasty (seven studies), respectively. The pooled rate of clinical success, based on the GCSI score, with G-POEM was 75.8% (95% CI 68.1–82.1, I2 = 50) and with surgical pyloroplasty was 77.3% (95% CI 66.4–85.4, I2 = 0), with no significance, p = 0.81. The pooled rate of clinical success, based on the 4-hour GES results, with G-POEM was 85.1% (95% CI 68.9–93.7, I2 = 74) and with surgical pyloroplasty was 84% (95% CI 64.4–93.8, I2 = 81), with no significance, p = 0.91. The overall adverse events were comparable. Based on meta-regression analysis, idiopathic gastroparesis, prior treatment with botulinum toxin and gastric stimulator seemed to predict clinical success with G-POEM. Conclusion: G-POEM demonstrates clinical success in treating refractory gastroparesis. Idiopathic gastroparesis, prior treatment with botulinum injections and gastric stimulator appear to have positive predictive effects on the 4-h GES results after G-POEM. Outcomes seem comparable to surgical pyloroplasty.
KW - G-POEM
KW - Pyloroplasty
KW - Refractory gastroparesis
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U2 - 10.1007/s00464-019-07135-9
DO - 10.1007/s00464-019-07135-9
M3 - Article
C2 - 31583465
AN - SCOPUS:85073999241
SN - 0930-2794
VL - 34
SP - 3352
EP - 3367
JO - Surgical endoscopy
JF - Surgical endoscopy
IS - 8
ER -