Multicenter Retrospective Study on G-POEM for Refractory Gastroparesis in Post-Lung Transplant Patients

Background: Gastroparesis is a common complication after lung transplantation, characterized by delayed gastric emptying that causes nausea, vomiting, and abdominal distension. It is often severe, refractory to medical therapy, and may require surgical intervention. This condition can lead to respiratory complications such as microaspiration and obliterative bronchiolitis. Gastric per-oral endoscopic myotomy (G-POEM) has emerged as a promising treatment for refractory cases. Methods: This multicenter retrospective study included post-lung transplant patients who underwent G-POEM for medically refractory gastroparesis at four U.S. tertiary centers. The primary outcome was clinical response, defined as a ≥1-point improvement in the Gastroparesis Cardinal Symptom Index (GCSI). Results: Fifty-eight patients (mean age 53.8 ± 12.0 years; 32 female) underwent G-POEM at a median of 12.5 months post-transplant. Gastroparesis was diagnosed at a median of 4.8 months post-transplant, with severe to very severe delayed gastric emptying in 47 of 52 patients based on gastric emptying studies. Fourteen patients (24.1%) were dependent on a gastrojejunostomy tube at baseline. On follow-up, 9 of 13 patients with available data were able to discontinue tube feeds and tolerate a regular diet. All procedures were technically successful. Clinical success was achieved in 73% of patients, with no intraprocedural or postprocedural complications. Follow-up gastric emptying studies were available in 36 patients, of whom 29 showed improvement or normalization. Conclusions: This study demonstrates that G-POEM is a safe and effective treatment for refractory gastroparesis in lung transplant recipients and represents a viable option for this complex patient population, warranting further studies to confirm long-term outcomes.