S3116 Increasing Adoption of Gastric Per-Oral Endoscopic Myotomy Over Gastric Electrical Stimulation for Refractory Gastroparesis: A Nationwide Analysis (2015-2024)

Introduction: Gastroparesis (GP) patients often suffer from persistent symptoms and are refractory to medical therapy. This study aims to evaluate nationwide utilization trends of nonpharmacological interventions, specifically gastric electrical stimulation (GES) and gastric per-oral endoscopic myotomy (G-POEM), in the management of refractory GP. Methods: A retrospective analysis was conducted using the TriNetX database from 2015 to 2025, including adult patients aged ≥18 years undergoing GES or G-POEM, identified via CPT and ICD-9/10 procedure codes. Statistical analyses, including Chi-square tests, ANOVA, and trend regression analyses (Annual Percent Change [APC]), were performed using the TriNetX platform and R software, with statistical significance defined at P ≤ 0.05. Results: Of the 283,360 GP patients identified, 4,494 (1.6%) underwent nonpharmacological interventions: 2,780 (61.9%) received GES and 1,714 (38.1%) underwent G-POEM. Intervention recipients were predominantly women (48.3% GES vs 32.4% G-POEM; P < 0.01) and White (43.1% vs 30.2%; P < 0.01), though substantial proportions were Black (35.1% vs 25.1%; P < 0.01) and Hispanic (44.4% vs 38.5%; P < 0.01). Although overall intervention volume increased over time, there was no significant linear trend (P = 0.8). However, the distribution of intervention types shifted significantly. For example, GES utilization declined from 80% (2015-2016) to 53% in 2023-2024 (APC -8.5%; P < 0.01), while G-POEM utilization increased from 20% to 47% over the same period (APC +26.4%; P < 0.01). By 2023-2024, G-POEM use exceeded GES among patients younger than 40 years (incidence proportion 0.69% vs 0.43%; P = 0.03). Conclusion: This large-scale, real-world analysis demonstrates a marked shift toward G-POEM over GES for refractory gastroparesis, particularly among younger patients. Prospective, randomized sham-controlled studies are needed to compare efficacy, safety, durability, and cost-effectiveness of G-POEM to optimize individualized treatment algorithms in this complex population.