SUN-605 Analyzing Long-term Outcomes Following G-poem For Refractory Idiopathic Or Diabetic Gastroparesis: A Meta-analysis & Systematic Review

Abstract Disclosure: M. Ismail: None. N. Sardarova: None. O. Khan: None. S. Ali: None. J. Klein: None. M. Barawi: None. Background: In recent years, gastric peroral endoscopic myotomy (G-POEM) has emerged as aneffective minimally invasive therapy for refractory gastroparesis. While short-term (1 year) and intermediate-term (2 year) outcomes have been promising, long-term durability beyond four years requires further elucidation. Objective: To systematically evaluate the clinical and physiologic outcomes of G-POEM in patients with refractory gastroparesis, be it idiopathic or secondary due to uncontrolled diabetes, with follow-up periods of at least four years and beyond. Methods: A comprehensive search of PubMed, Embase, and Cochrane databases through April 2025 identified studies reporting outcomes at ≥4 years post-G-POEM. Primary endpoints included sustained symptomatic improvement (measured by Gastroparesis Cardinal Symptom Index [GCSI]), normalization or improvement in gastric emptying scintigraphy (GES), need for repeat intervention, and adverse events (Infection, Perforation, Bleeding). Pooled analyses were performed using random-effects models. Results: Nine studies comprising 472 patients were included. At ≥4 years post-procedure, the pooled clinical success rate based on symptom control (≥1-point decrease in GCSI) was 66.8%(95% CI, 61.0-72.2). Mean GCSI scores improved from a baseline of 3.6 ± 0.4 to 1.8 ± 0.5 at last follow-up (p < 0.001). GES data showed a significant reduction in gastric retention at 4 hours, with normalization (≤10% retention) achieved in 58.5% of patients and partial improvement(>50% reduction from baseline) in an additional 21.4%. Symptom recurrence was reported in 24.1% of cases, most commonly within three years. Repeat intervention was required in 13.7% of patients. Serious adverse events, including bleeding, perforation, and infections, were rare(2.7%), with no mortality being reported. Pre-procedural pyloric distensibility, as measured by Endo-FLIP, correlated with long-term treatment durability. Conclusion: G-POEM offers durable symptom improvement and sustained enhancement of gastric emptying in most patients with refractory gastroparesis over a four-year follow-up period. Incorporation of pre-procedural physiological assessments may optimize patient selection and improve long-term outcomes. Further prospective multicenter studies are warranted to validate predictors of sustained benefit. Further studies should also focus on the pathophysiology of interstitial cells of Cajal and their role in the development of gastroparesis. Presentation: Sunday, July 13, 2025