S3152 Comparative Efficacy of Surgical and Endoscopic Pyloric Interventions in Gastroparesis: A Systematic Review and Meta-Analysis

Introduction: Gastroparesis is a chronic gastrointestinal motility disorder characterized by delayed gastric emptying without mechanical obstruction. While pharmacological therapy is often the initial approach, refractory cases necessitate procedural intervention. pyloroplasty, peroral pyloromyotomy (POP), and gastric peroral endoscopic myotomy (G-POEM) have emerged as key therapeutic options. This meta-analysis aims to evaluate and compare their efficacy using the Gastroparesis Cardinal Symptom Index (GCSI) and 4-hour gastric retention percentages. Methods: A systematic search of PubMed, Embase, and Cochrane Library was conducted to identify studies reporting outcomes of pyloroplasty, POP, and G-POEM in adult gastroparesis patients. Extracted data included pre- and post-intervention GCSI scores and 4-hour gastric retention percentages. Pooled estimates were calculated using a random-effects model. Heterogeneity was assessed using the I2 statistic. Results: A total of 23 studies comprising 1,419 participants met inclusion criteria. All interventions showed symptomatic and physiological improvements. Pyloroplasty (2 studies): GCSI score improved from 3.66 (95% CI 3.045-4.276) to 2.465 (CI 2.370-2.559); gastric retention improved from 9.034% (CI -3.872-21.940) to 32.991% (CI 27.210-38.772). POP (2 studies): GCSI score reduced from 3.788 (CI 3.397-4.179) to 2.326 (CI 2.051-2.601); retention improved from 10.884% (CI 9.392-12.376) to 33.302% (CI 31.223-35.380). G-POEM (6 studies): GCSI improved from 3.129 (CI 2.426-2.832) to 1.703 (CI 1.125-2.280); retention from 27.778% (CI 17.466-38.090) to 38.664% (CI 29.383-47.904). Heterogeneity ranged from low to high across variables (I2: 0%-99.2%). Conclusion: Pyloroplasty, POP, and G-POEM are effective in improving both symptoms and gastric emptying in patients with gastroparesis. G-POEM, supported by the largest number of studies, demonstrated the most robust outcomes. These findings support the expanding role of pyloric-directed therapies in gastroparesis management, but head-to-head trials are needed for definitive guidance.