Response to Dr. Frieling

We would like to thank Dr. Frieling for his interest and comments regarding our recent publication “Gastric peroral endoscopic pyloromyotomy versus gastric electrical stimulation in the treatment of refractory gastroparesis: a propensity score-matched analysis of long term outcomes” [1].

Firstly, refractory gastroparesis is a chronic disease with a high relapse rate when treated conservatively, and there is currently no effective treatment that halts or reverses disease progression. Our study included patients who had failed conservative treatments and suffered from severe nausea and vomiting, with very high gastroparesis cardinal symptom index (GCSI) and repeated episodes of hospitalization. The purpose of the study was to compare the clinical outcome of gastric peroral endoscopic pyloromyotomy (G-POEM or POP) and gastric electrical stimulation (GES) for these patients with refractory symptoms. Therefore, Dr. Frieling may be underestimating the severity of illness among the patients included in this study.

Secondly, compared with conservative treatments, both G-POEM and GES have significantly lower recurrence rates at 1 – 2 years [2] [3] [4]. Also, our data showed the drug and nutrition dependence of patients without recurrence was lower than that of patients with relapse.

Thirdly, antidepressants and analgesics are used to treat gastroparesis [5]. The usage rates of these drugs were the same between the two groups before treatment, and the usage decreased after these two procedures in both groups with no statistical difference. This suggests both G-POEM and GES alleviate patient's symptoms to some extent. Also, our follow-up data indicated that G-POEM could improve the patient's GCSI score in the longer term.

Indeed, as pointed out by Dr. Frieling, we did not draw a correlation between improved gastric emptying and improved symptoms. However, the primary endpoint of this study (relapse) was not merely based on gastric emptying, but also on the long-term symptom improvement (over 6 months) and no episodes of hospitalization.

Based on the results of this study, we believe that G-POEM is a promising treatment for gastroparesis.

Publication History

Article published online:
17 December 2020

• References

• 1 Shen S, Luo H, Vachaparambil C. et al. Gastric peroral endoscopic pyloromyotomy versus gastric electrical stimulation in the treatment of refractory gastroparesis: a propensity score-matched analysis of long term outcomes. Endoscopy 2020; 52: 349-358
• 2 Heckert J, Sankineni A, Hughes WB. et al. Gastric electric stimulation for refractory gastroparesis: a prospective analysis of 151 patients at a single center. Dig Dis Sci 2016; 61: 168-175
• 3 Mekaroonkamol P, Patel V, Shah R. et al. Association between duration or etiology of gastroparesis and clinical response after gastric per-oral endoscopic pyloromyotomy. Gastrointest Endosc 2019; 89: 969-976
• 4 Pasricha PJ, Yates KP, Nguyen L. et al. Outcomes and factors associated with reduced symptoms in patients with gastroparesis. Gastroenterology 2015; 149: 1762-1774
• 5 Hasler WL. Symptomatic management for gastroparesis: antiemetics, analgesics, and symptom modulators. Gastroenterol Clin North Am 2015; 44: 113-126