Gastric peroral endoscopic myotomy versus surgical pyloromyotomy/pyloroplasty for refractory gastroparesis: systematic review and meta-analysis

Muhammad Aziz; Manesh Kumar Gangwani; Hossein Haghbin; Dushyant Singh Dahiya; Amir Humza Sohail; Faisal Kamal; Wade Lee-Smith; Douglas G Adler

doi:10.1055/a-1980-9942

Gastric peroral endoscopic myotomy versus surgical pyloromyotomy/pyloroplasty for refractory gastroparesis: systematic review and meta-analysis

Endosc Int Open. 2023 Apr 4;11(4):E322-E329. doi: 10.1055/a-1980-9942. eCollection 2023 Apr.

Authors

Muhammad Aziz¹, Manesh Kumar Gangwani², Hossein Haghbin³, Dushyant Singh Dahiya⁴, Amir Humza Sohail⁵, Faisal Kamal⁶, Wade Lee-Smith⁷, Douglas G Adler⁸

Affiliations

¹ Division of Gastroenterology and Hepatology, University of Toledo, Toledo, Ohio, United States.
² Department of Internal Medicine, University of Toledo, Toledo, Ohio, United States.
³ Division of Gastroenterology, Ascension Providence Southfield, Southfield, Michigan, United States.
⁴ Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, Michigan, United States.
⁵ Department of Surgery, NYU Langone Health, Long Island, New York, United States.
⁶ Division of Gastroenterology, University of California San Francisco, San Francisco, California, United States.
⁷ University of Toledo Libraries, University of Toledo, Toledo, Ohio, United States.
⁸ Centura Health, Center for Advanced Therapeutic Endoscopy, Englewood, Colorado, United States.

Abstract

Background and study aims Gastric per-oral endoscopic myotomy (G-POEM) has been recently compared with surgical techniques (i. e. pyloromyotomy and pyloroplasty) for managing patients with refractory gastroparesis. Given the varying results, we performed a systematic review and meta-analysis of available studies to assess the safety and efficacy of each technique. Patients and methods A comprehensive review of the literature using the following databases was undertaken through July 29, 2022: MEDLINE, Embase, Web of Science, KCI - Koran Journal index, Global Index Medicus, and Cochrane. Comparative studies including case-control, cohort and randomized controlled trials (RCTs) were included. Random effects model using DerSimonian laird approach was used to compare outcomes. Relative risk (RR) and mean difference (MD) were calculated for binary and continuous outcomes respectively. Results A total of four studies with 385 patients (216 in the G-POEM group and 169 in the surgical group were included. The mean age was 46.9 (± 3.41) and 46.2 (± 0.86) and the female proportion was 79.6 % and 74.0 % for the G-POEM and surgery group respectively. The mean procedural time (MD: -59.47 mins, P < 0.001) and length of hospital stay (MD: -3.10 days, P < 0.001) was significantly lower for G-POEM compared to surgery. The post procedure GCSI score (MD: -0.33, P = 0.39) and reduction in GCSI score preoperatively and postoperatively (MD: 0.27, P = 0.55) was not significantly different. Conclusions G-POEM appears promising as it may provide a cost-effective approach for managing refractory gastroparesis compared to surgical techniques. RCTs are needed to further confirm these results.

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