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

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.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.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.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.

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Journal
Endoscopy
Published
2025-11-04
DOI
https://doi.org/10.1055/a-2718-4945
Primary Topic
Gastrointestinal motility and disorders
Type
article
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article

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

Marc Barthet, Maximilien Barret, Philippe Ah‐Soune, Ludovic Caillo et al.
Endoscopy
Gastrointestinal motility and disorders
article

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

Marc Barthet, Maximilien Barret, Philippe Ah‐Soune, Ludovic Caillo, Fabrice Caillol, Julien Branche, Arthur Berger, Sébastien Godat, Jan Mareš, Thibault Degand, Serge Leblanc, Jean‐Michel Gonzalez, Kristína Hugová, Jan Martínek, Geoffroy Vanbiervliet, Jérémie Jacques, Antoine Debourdeau, Timothée Wallenhorst, Pierre-Jean Silete, Magdalena Houzvickova, Mathieu Pioche, Stéphane Koch, Jérôme Rivory, Vincent Lépilliez, Jean-Philippe Ratone
article en

Abstract

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.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.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.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.

EndoscopyVol. 58(04)
Centre Hospitalier Universitaire de Bordeaux (FR), Université Rennes 2 (FR), Centre Hospitalier Universitaire de Besançon (FR), Lille’s Cardiology Hospital (FR), Hôpital Cochin (FR), Centre Hospitalier Universitaire de Montpellier (FR), Methodology and Quality of Life Unit in Oncology (FR), Centre Hospitalier Universitaire de Nîmes (FR), Hôpital Nord (FR), CHU Dijon Bourgogne (FR), Hôpital l'Archet (FR), Hôpital Edouard Herriot (FR), Hôpital Privé Jean Mermo (FR), Institute of Clinical and Experimental Medicine (CZ), St. Anne's University Hospital Brno (CZ), Hôpital d'Instruction des Armées Sainte-Anne (FR), Maison des Sciences sociales et des Humanités de Dijon (FR), Institut Paoli-Calmettes (FR), Centre Hospitalier Intercommunal Toulon-La Seyne-sur-Mer (FR), Centre Hospitalier Universitaire de Rennes (FR), Hôpital Dupuytren (FR), Université de Rennes (FR), University of Lausanne (CH)
Openalex Percentile: Top 54%
Gastrointestinal motility and disorders
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