S2241 Redo Gastric Peroral Endoscopic Myotomy Is Associated With Improvement in Symptoms and Regain of Clinical Success for Refractory Gastroparesis: A Single Center Experience

Introduction: Gastric peroral endoscopic myotomy (G-POEM) showed promising results in improving gastroparesis (GP) related symptoms and quality of life (QoL). Nevertheless, a proportion of patients fail to respond to G-POEM after initial improvement. Redo G-POEM has been proposed as a management option in this case, but data on safety, feasibility, and outcomes of G-POEM in this group remains scarce. We aimed to assess the safety and describe clinical and scintigraphy outcomes after redo G-POEM. Methods: Prospectively enrolled patients who underwent an initial G-POEM followed by a redo G-POEM at a single institution from February 2018 to May 2025 were included. All redo G-POEM procedures were performed at least 6 months post the initial G-POEM. Evaluations were conducted at baseline and 6 months for the initial and redo G-POEMs. Validated tools were used to assess patient outcomes, including Gastroparesis Cardinal Symptom Index (GCSI), Patient Assessment of Gastrointestinal Disorders Symptom Severity Index (PAGI-SYM), and 36-Item Short Form Survey (SF-36). Additionally, 4-hour solid phase gastric emptying scan (GES) results were recorded. Clinical success of redo G-POEM was defined as improvement in GCSI scores by ≥1 point compared to baseline. Results: Fourteen patients (92.9% woman, mean age 48.4 ± 14.2 years) were included in this study. Seven patients (50.0%) had idiopathic, 4 (28.6%) had diabetic, and 3 (21.4%) had post-surgical GP. The median (interquartile range) for the time between initial and redo G-POEMs was 12 (8-27) months. The mean total GCSI score markedly improved from a baseline prior to initial G-POEM of 3.5(±0.8) to 2.4(±1.5) at 6 months post-redo G-POEM (P = 0.047). The average PAGI-SYM total score significantly improved from a baseline prior to initial G-POEM of 3.2(±0.9) to 2.2(±1.3) at 6 months post-redo G-POEM (P = 0.008). The mean SF 36 QOL total score and mean 4-hour gastric retention using GES showed improvement trends after redo G-POEM but did not reach statistical significance. Clinical success (using the post G-POEM failure GSCI score) was achieved in 50.0% of patients who underwent redo G-POEM. There were no reported adverse events. Conclusion: Redo G-POEM significantly improved symptom severity for patients with primary failures or those who experienced symptom recurrence post G-POEM with no associated adverse events. Additional research involving a larger cohort is required to determine which patients would derive the greatest benefit from redo G-POEM.