CLINICAL RESPONSE TO GASTRIC PERORAL ENDOSCOPIC MYOTOMY AND ITS ASSOCIATION TO CHANGES IN PYLORIC IMPEDANCE PLANIMETRY MEASUREMENTS: A SYSTEMATIC REVIEW AND META ANALYSIS

Harsimran Kalsi; Saurabh Chandan; Jay Bapaye; Babu P. Mohan; Abdullah Abbasi; Sagar Pathak; Ernesto Robalino Gonzaga; Deepanshu Jain; Natalie D. Cosgrove; Kambiz S. Kadkhodayan; Mustafa A. Arain; Muhammad K. Hasan; Maham Hayat; Dennis Yang

doi:10.1016/j.gie.2026.01.008

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CLINICAL RESPONSE TO GASTRIC PERORAL ENDOSCOPIC MYOTOMY AND ITS ASSOCIATION TO CHANGES IN PYLORIC IMPEDANCE PLANIMETRY MEASUREMENTS: A SYSTEMATIC REVIEW AND META ANALYSIS

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CLINICAL RESPONSE TO GASTRIC PERORAL ENDOSCOPIC MYOTOMY AND ITS ASSOCIATION TO CHANGES IN PYLORIC IMPEDANCE PLANIMETRY MEASUREMENTS: A SYSTEMATIC REVIEW AND META ANALYSIS

Harsimran Kalsi, Saurabh Chandan, Jay Bapaye, Babu P. Mohan, Abdullah Abbasi, Sagar Pathak, Ernesto Robalino Gonzaga, Deepanshu Jain, Natalie D. Cosgrove, Kambiz S. Kadkhodayan, …

Gastrointestinal endoscopy, Vol.104(1), pp.100-104.e2

07/2026

DOI: 10.1016/j.gie.2026.01.008

PMID: 41548721

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Abstract

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 patients and predict a favorable response to G-POEM. We performed a systematic review and meta-analysis to evaluate pyloric functional luminal imaging probe (FLIP) changes in patients undergoing G-POEM. Pre- and post-G-POEM data were collected and analyzed. Clinical response was defined as an improvement of at least 1 point in the mean overall Gastroparesis Cardinal Symptom Index (GCSI) score, consistent with criteria used across included studies. 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. Four studies involving 203 patients (76.7% women, mean age 55.2 years), were included in the final analysis. Overall pooled clinical success and failure rates were 70.3% (CI 63.5-76.3; I2 0%) and 31.3% (CI 25.3-38.3; I2 0%), respectively. There were no differences between the responders vs. non-responders in baseline pyloric FLIP measurements. We found 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, 183.1 mm2 (163.8-202.5) vs 146.9 mm2 (125.1-168.8); SMD -0.71 (-0.99 to -0.43); P<0.001; I2=0% but not in non-responders following G-POEM. Our analysis shows that 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.

Cross Sectional Area

Distensibility Index

Endoscopic Functional Luminal Imaging Probe

Gastric peroral endoscopic myotomy

Gastroparesis Cardinal Symptom Index

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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 Kalsi - University of Florida
Saurabh Chandan - Houston Methodist
Jay Bapaye - Carilion Clinic
Babu P. Mohan - Orlando Gastroenterology PA, Orlando, FL, USA
Abdullah Abbasi - University of Iowa
Sagar Pathak - Loma Linda University
Ernesto Robalino Gonzaga - University of Pennsylvania
Deepanshu Jain - AdventHealth Orlando
Natalie D. Cosgrove - AdventHealth Orlando
Kambiz S. Kadkhodayan - AdventHealth Orlando
Mustafa A. Arain - AdventHealth Orlando
Muhammad K. Hasan - AdventHealth Orlando
Maham Hayat - AdventHealth Orlando
Dennis Yang - AdventHealth Orlando
Resource Type: Journal article
Publication Details: Gastrointestinal endoscopy, Vol.104(1), pp.100-104.e2
DOI: 10.1016/j.gie.2026.01.008
PMID: 41548721
NLM abbreviation: Gastrointest Endosc
ISSN: 0016-5107
eISSN: 1097-6779
Publisher: Elsevier Inc
Grant note: The 3D Matrix and Microtech HCA Healthcare
The following authors disclosed financial relationships: N. D. Cosgrove: Consultant for Olympus and Boston Scientific. M. A. Arain: Consultant for Olympus, Boston Scientific, and Cook. M. K. Hasan: Consultant for Olympus America, Micro-Tech Endoscopy, and Boston Scientific. D. Yang: Consultant for Fujifilm, 3D Matrix, Neptune Medical, Olympus, Medtronic, Microtech, and Boston Scientific; grant/research support from 3D Matrix and Microtech. All other authors disclosed no financial relationships. No external funding was received for the conduct of this study. This work was supported in whole or in part by HCA Healthcare and/or an HCA Healthcare-affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.
Language: English
Electronic publication date: 01/16/2026
Date published: 07/2026
Academic Unit: Internal Medicine
Record Identifier: 9985130237202771

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