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Endoscopy 2021; 53(05): 480-490
DOI: 10.1055/a-1205-5686
Original article

One-year results of gastric peroral endoscopic myotomy for refractory gastroparesis: a French multicenter study

Olivier Ragi‡   *
1   Service de gastroentérologie, CHU Limoges, France
,
Jérémie Jacques‡   *
1   Service de gastroentérologie, CHU Limoges, France
2   CNRS, XLIM, UMR 7252, Limoges, France.
,
Julien Branche
3   Service de gastroentérologie, CHU Claude Huriez, Lille, France
,
Sarah Leblanc
4   Service de gastroentérologie, APHP, Hôpital Cochin, Paris, France
,
Geoffroy Vanbiervliet
5   Service de gastroentérologie, CHU L’Archet 2, Nice, France
,
Romain Legros
1   Service de gastroentérologie, CHU Limoges, France
,
Mathieu Pioche
6   Service de gastroentérologie, HCL Edouard Herriot, Lyon, France
,
Jérôme Rivory
6   Service de gastroentérologie, HCL Edouard Herriot, Lyon, France
,
Stanislas Chaussade
4   Service de gastroentérologie, APHP, Hôpital Cochin, Paris, France
,
Maximilien Barret
4   Service de gastroentérologie, APHP, Hôpital Cochin, Paris, France
,
Timothée Wallenhorst
7   Service de gastroentérologie, CHU Pontchailloux, Rennes, France
,
Marc Barthet
8   Service de gastroentérologie, APHM, Hôpital Nord, Marseille, France
,
Sébastien Kerever
9   Department of Anesthesiology and Critical Care, Saint Louis Lariboisière Fernand Widal University Hospital, AP-HP, Paris, France
,
Jean-Michel Gonzalez
8   Service de gastroentérologie, APHM, Hôpital Nord, Marseille, France
› Author AffiliationsTrial Registration: ClinicalTrials.gov Registration number (trial ID): NCT04024709 Type of study: retrospective, multi-center study.
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Author commentary on Olivier Ragi et al.Endoscopy 2021; 53(05): v20-v20
DOI: 10.1055/a-1251-4166

Abstract

Background: Data on the long-term outcomes of gastric peroral endoscopic myotomy (G-POEM) for refractory gastroparesis are lacking. We report the results of a large multicenter long-term follow-up study of G-POEM for refractory gastroparesis.

Methods: This was a retrospective multicenter study of all G-POEM operations performed in seven expert French centers for refractory gastroparesis with at least 1 year of follow-up. The primary endpoint was the 1-year clinical success rate, defined as at least a 1-point improvement in the Gastroparesis Cardinal Symptom Index (GCSI).

Results: 76 patients were included (60.5 % women; age 56 years). The median symptom duration was 48 months. The median gastric retention at 4 hours (H4) before G-POEM was 45 % (interquartile range [IQR] 29 % – 67 %). The median GCSI before G-POEM was 3.6 (IQR 2.8 – 4.0). Clinical success was achieved in 65.8 % 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 score was predictive of clinical success (odds ratio [OR] 3.41, 95 % confidence interval [CI] 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, 95 %CI 0.95 – 1.00; P = 0.03).

Conclusions: The results confirm the efficacy of G-POEM for the treatment of refractory gastroparesis, as evidenced by a 65.8 % clinical success rate at 1 year. Although 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.



Publication History

Received: 25 February 2020

Accepted: 23 June 2020

Accepted Manuscript online:
23 June 2020

Article published online:
21 July 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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