S2189 Assessing the Impact and Safety of Redo G-POEM for Refractory Gastroparesis: Insights From an International Multicenter Study

Introduction: Gastric peroral endoscopic myotomy (G-POEM) has been shown to alleviate symptoms of refractory gastroparesis in 48% to 71% of cases. However, up to 44% of patients continue to experience symptoms within 12 months of the procedure, with an annual relapse rate reaching approximately 13%. Redo G-POEM has emerged as a potential solution for such patients, although evidence regarding its safety and efficacy remains scarce. This international multicenter study aims to assess the clinical effectiveness and safety of redo G-POEM, leveraging data from high-volume tertiary centers specializing in Third Space Endoscopy. Methods: We conducted a retrospective multicenter study to identify patients with refractory gastroparesis who underwent G-POEM between January, 2021 and March, 2025. From this cohort, we identified individuals with a history of surgical pyloroplasty or prior G-POEM who subsequently underwent a repeat G-POEM due to ongoing or recurrent symptoms. The primary outcome was clinical response at 3-months or longer, defined as a ≥1-point improvement in the Gastroparesis Cardinal Symptom Index (GCSI). Procedure-related adverse events were also recorded. Results: Sixteen patients (mean age 43.93 ± 16.56 years; 75% woman) were included in the study. Of these, 3 patients (18.75%) underwent G-POEM following prior surgical pyloroplasty. The mean duration of symptoms was 5.5 ± 5.14 years. Gastroparesis etiologies included idiopathic (n = 7), diabetic (n = 6), post-surgical (n = 2) and post-lung transplant (n = 1). The average interval between procedures was 1.10 ± 0.75 years. At baseline, gastroparesis severity was classified as very severe in 6 patients, moderate in 5, severe in 2 and mild in one; 2 lacked pre-procedure GES. Redo G-POEM was performed in 7 patients due to symptom recurrence after initial improvement (without further testing) and in 6 patients due to persistent gastric retention on GES along with persistent symptoms. Among the 15 patients with available follow-up GCSI scores within 3 months, 8 (53%) showed clinical response. One intraprocedural perforation occurred and was managed with through-the-scope clipping. Two additional patients required hospitalization for nausea and vomiting, but no other adverse events were reported. Conclusion: Redo G-POEM is a technically feasible and safe intervention that offers modest clinical benefit. Prospective studies are needed to identify predictors of response and optimize patient selection.