Abstract
CLINICAL RESPONSE TO GASTRIC PERORAL ENDOSCOPIC MYOTOMY AND ITS ASSOCIATION TO CHANGES IN PYLORIC IMPEDANCE PLANIMETRY MEASUREMENTS: A SYSTEMATIC REVIEW AND META ANALYSIS
Gastrointestinal endoscopy, Vol.101(5 Supplement), pp.S627-S628
05/2025
DOI: 10.1016/j.gie.2025.03.884
Abstract
Background
Gastric per-oral endoscopic myotomy (G-POEM) has emerged as a potential therapy for patients with medically refractory gastroparesis. While adequate patient selection is crucial, there is a paucity of data on factors that may help select for patients and predict a favorable response to G-POEM. Functional luminal imaging probe (FLIP) uses impedance to provide real-time dynamic assessment of the pyloric sphincter physiology. We performed a systematic review and meta-analysis to evaluate pyloric FLIP changes in patients undergoing G-POEM.
Methods
We systematically searched multiple databases until November 2024 for studies reporting on the use of FLIP in GPOEM patients. Pre- and post-G-POEM data was collected and analyzed. Clinical response was defined as ≥ 50% reduction in gastroparesis symptoms, measured by the Gastroparesis Cardinal Symptom Index (GCSI). Standardized mean differences (SMD) compared metrics between groups (responders vs non-responders), and pooled success rates with 95% confidence intervals (CI) were estimated with random-effects models, with heterogeneity assessed by I2.
Results
Four studies involving 202 patients (76.7% women, mean age 55.2 years), were included in the final analysis. The most common etiologies for gastroparesis were idiopathic (73 patients, 36.13%), diabetes (63 patients, 31.19%), and post-surgery (55 patients, 27.23%). Overall pooled clinical success and failure rates were 70.0% (CI 63.3-76.1; I2 0%) and 31.44% (CI 25.3-38.31; I2 0%), respectively. Baseline GCSI scores were significantly higher among responders vs. non-responders, SMD 0.21 (CI 0.06-0.36; p=0.006; I2 77%). There were no differences between the responders vs. non-responders in baseline pyloric FLIP measurements. There was a statistically significant increase in the distensibility index (DI) following G-POEM in both groups. Conversely, pylorus cross-sectional area (CSA) only improved significantly among responders (SMD 35.34 mm2, CI 48.56-22.13; p<0.0001) but not in non-responders (SMD 11.31 mm2, CI 36.94-14.33; p=0.43) following G-POEM.
Conclusion
G-POEM is an effective therapy for patients with medically refractory gastroparesis. Identifying potential predictors of response is key in adequately selecting patients that may benefit from this procedure. In this study, patients who responded to G-POEM had higher baseline GCSI scores when compared to non-responders. Post-G- POEM pylorus CSA was associated with clinical response. FLIP may provide objective assessment of pyloric changes and be a potential tool to predict clinical outcome of G-POEM. Additional studies with standardized FLIP protocols in patients undergoing G-POEM are needed.
Details
- Title: Subtitle
- CLINICAL RESPONSE TO GASTRIC PERORAL ENDOSCOPIC MYOTOMY AND ITS ASSOCIATION TO CHANGES IN PYLORIC IMPEDANCE PLANIMETRY MEASUREMENTS: A SYSTEMATIC REVIEW AND META ANALYSIS
- Creators
- Harsimran KalsiSaurabh ChandanJay BapayeBabu P. MohanAbdullah AbbasiSagar PathakErnesto Robalino GonzagaDeepanshu JainNatalie D. CosgroveKambiz S. KadkhodayanMustafa A. ArainMuhammad K. HasanMaham HayatDennis Yang
- Resource Type
- Abstract
- Publication Details
- Gastrointestinal endoscopy, Vol.101(5 Supplement), pp.S627-S628
- DOI
- 10.1016/j.gie.2025.03.884
- ISSN
- 0016-5107
- Language
- English
- Date published
- 05/2025
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984843739802771
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