Endoscopy 2020; 52(05): 349-358
DOI: 10.1055/a-1111-8566
Original article

Gastric peroral endoscopic pyloromyotomy versus gastric electrical stimulation in the treatment of refractory gastroparesis: a propensity score-matched analysis of long term outcomes

Shanshan Shen*
1   Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, United States
2   Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
,
Hui Luo*
1   Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, United States
3   State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, Shaanxi, China
,
Cicily Vachaparambil
1   Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, United States
,
Parit Mekaroonkamol
1   Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, United States
4   Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand
,
Mohamed M. Abdelfatah
1   Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, United States
,
Guifang Xu
1   Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, United States
2   Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
,
Huimin Chen
1   Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, United States
5   Division of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
,
Liang Xia
1   Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, United States
6   Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
,
Hong Shi
1   Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, United States
7   Department of Gastrointestinal Endoscopy, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, Fujian, China
,
Steve Keilin
1   Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, United States
,
Field Willingham
1   Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, United States
,
Jennifer Christie
1   Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, United States
,
Edward Lin
1   Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, United States
,
Qiang Cai
1   Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, United States
› Author Affiliations


Abstract

Background Gastric peroral endoscopic pyloromyotomy (G-POEM) and gastric electrical stimulation (GES) have been reported as treatment options for refractory gastroparesis. In this study, we compared the long term clinical outcomes of G-POEM versus GES in the treatment of such patients.

Methods We retrospectively evaluated 111 consecutive patients with refractory gastroparesis between January 2009 and August 2018. To overcome selection bias, we used propensity score matching (1:1) between G-POEM and GES treatment. The primary outcome was the duration of clinical response.

Results After propensity score matching, 23 patients were included in each group. After a median follow-up of 27.7 months, G-POEM had a significantly better and longer clinical response than GES (hazard ratio [HR] for clinical recurrence 0.39, 95 % confidence interval [CI] 0.16 – 0.95; P = 0.04). The median duration of response was 25.4 months (95 %CI 8.7 – 42.0) in the GES group and was not reached in the G-POEM group. The Kaplan – Meier estimate of 24-month clinical response rate was 76.6 % with G-POEM vs. 53.7 % with GES. GES appeared to have little effect on idiopathic gastroparesis (HR for recurrence with G-POEM vs. GES 0.35, 95 %CI 0.13 – 0.95; P = 0.05). The incidence of adverse events was higher in the GES group (26.1 % vs. 4.3 %; P = 0.10).

Conclusion Among patients with refractory gastroparesis, clinical response was better and lasted longer with G-POEM than with GES. The positive outcomes with G-POEM are likely to derive from the superior clinical response in patients with idiopathic gastroparesis. Further studies are needed to confirm these findings.

* These authors contributed equally to this work.




Publication History

Received: 11 June 2019

Accepted: 15 January 2020

Article published online:
21 February 2020

© Georg Thieme Verlag KG
Stuttgart · New York