Gastric peroral endoscopic pyloromyotomy for refractory gastroparesis following esophagectomy: results from a multicenter series

Abstract

Background

Gastroparesis is predominantly caused by diabetes mellitus or vagal nerve injury post-surgery. About 30% of patients develop gastroparesis after esophagectomy with gastric pull-through. Standard treatments often fail, and endoscopic pyloromyotomy (G-POEM) has shown promising results. This study aimed to assess the efficacy and safety of G-POEM in patients with refractory gastroparesis after esophagectomy.

Methods

A multicenter retrospective cohort study was conducted across 18 expert centers. Patients who underwent G-POEM for refractory gastroparesis following esophagectomy from August 2014 to December 2023 were included. Inclusion criteria were confirmed gastroparesis by scintigraphy, a mean Gastroparesis Cardinal Symptom Index (GCSI) of at least 1.0, and a minimum of 6 months of follow-up. The primary outcome was treatment success at 6 months, defined as a ≥50% decrease in the GCSI score.

Results

Of 113 G-POEM procedures, 108 patients (median age 65 years; 75% men) met the inclusion criteria. The primary indication for esophagectomy was adenocarcinoma (75.5%). At 6 months, 63.5% (95%CI 54.1%–72.0%) achieved clinical success, with the mean GCSI significantly decreased to 1.2 (95%CI 1.0–1.4) from 2.9 (95%CI 2.7–3.1) preprocedure. Minor adverse events occurred in 2.8% of cases. Long-term follow-up showed sustained efficacy with success rates of 54.9% and 66.1% at 12 and 24 months, respectively.

Conclusion

G-POEM appears to be a safe and effective treatment for refractory gastroparesis in post-esophagectomy patients, achieving significant symptom relief in the majority of patients. Future prospective studies are necessary to further validate these findings and explore predictive factors for treatment success.

Publication History

Received: 25 November 2024

Accepted after revision: 20 September 2025

Article published online:
04 November 2025

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