GASTRIC PER-ORAL ENDOSCOPIC MYOTOMY (G-POEM) FOR COMPASSIONATE TREATMENT IN GASTROPARETIC PATIENTS ON CHRONIC OPIOIDS AND REFRACTORY SYMPTOMS

Maham Hayat; Abel Joseph; Yasi Xiao; Abdullah Abbasi; Saurabh Chandan; Sagar Pathak; Muhammad K. Hasan; Joo Ha Hwang; Dennis Yang

doi:10.1016/j.gie.2025.03.863

Background Opioid use among gastroparetic patients is common, with prior studies reporting rates as high as 41%. Most patients are unable to cease or wean opioid use and continue to endorse debilitating symptoms with poor quality-of-life and recurrent hospitalizations. The aim of this study was to evaluate the role of gastric per-oral endoscopic myotomy (G-POEM) as compassionate treatment in symptomatic gastroparetic patients on chronic opioids. Methods Multicenter retrospective analysis of prospective databases on consecutive gastroparetic patients with chronic opioid use who underwent G-POEM between January 2021 to September 2024. Pylorus diameter, cross- sectional area (CSA), balloon pressure, and distensibility index (DI) were evaluated at 40-50 mL balloon fills pre-G- POEM and at follow-up. Total daily opioid use was expressed in morphine mg equivalents (MME). Clinical response to G-POEM was defined as an improvement of ≥1 point on the Gastroparesis Cardinal Symptom Index (GCSI). Results Thirty-two gastroparetic patients on chronic opioids with a median follow-up of 6 months (range 3-18) underwent G-POEM during the study period. Technical success was 100%. There were no adverse events reported. Clinical success was achieved in 59.4% (19/32) of the patients at a median follow-up of 6 months. There were no differences in demographics, symptom duration, etiology of gastroparesis, baseline GSCI, gastric emptying scintigraphy, type of opioids or total daily MME between responders and non-responders (Table 1). When compared to non-responders, patients who responded to G-POEM had a significantly lower baseline pyloric diameter (13.2±3.4 mm2 vs. 15.6±2.7 mm2; p=0.04) and DI (4.8±1.9 mm2/mmHg vs. 8.4±4.6 mm2/mmHg; p=0.004). Clinical response after G-POEM was associated with improvement in FLIP parameters (Figure 1). Conclusions While G-POEM has emerged as a potential treatment for patients with medically refractory gastroparesis, its role as a compassionate treatment for symptomatic patients on chronic opioids has not been previously evaluated. In this study, we demonstrated an association between clinical response following G-POEM and improvement of pyloric FLIP parameters. Notably, baseline pyloric diameter and compliance, which were significantly lower among responders, may be potential predictors of response in patients on chronic opioids. Future larger studies with longer follow-up are needed to corroborate these initial findings and help tailor treatment in this patient population.

GASTRIC PER-ORAL ENDOSCOPIC MYOTOMY (G-POEM) FOR COMPASSIONATE TREATMENT IN GASTROPARETIC PATIENTS ON CHRONIC OPIOIDS AND REFRACTORY SYMPTOMS

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