Gastroparesis peroral endoscopic myotomy outcomes after 4 years of follow-up in a large cohort of patients with refractory gastroparesis

G-POEM is used for refractory gastroparesis (RG) with good early-term, but variable mid and long-term, outcomes. Limited data exist about candidates, long-term clinical and predictive factors. Our aim was to evaluate the 4-year follow-up efficacy and predictive factors in patients with RG.Confirmed RG patients were included and evaluated between April, 2017 and December, 2021. Gastroparesis Cardinal Symptom Index (GCSI), retention percentage at 4hours (RP4H), mean half emptying time (MHET) and short form survey (SF-36) were performed at 1,6,12,18,24,30,36,42 and 48-months.After G-POEM, 374 RG were included, 141(37.7%) had diabetic (DG); 115(30.7%) idiopathic (IG); 102(27.3%) postsurgical (PSG) gastroparesis; and 16 patients (4.3%) other etiologies. After 48-month evaluation, 102 completed follow-up (DG=58/ IG=22/PSG=18 and others=4). Before G-POEM GCSI, RP4H and MHET were 3.84±0.53, 44%(11-68) and 246min (150-368), respectively, and improved to GCSI=2.1±0.70, P<0.001; RP4H=15.5%(0-36), P=0.021 and MHET=135min (67-290), P=0.045, at 48-month evaluation. At 48-month evaluation, clinical success (CS) was 77.5%. DG showed the best outcomes (DG=86.5% vs IG=72.5%, P=0.001; vs PSG=72.1%, P=0.003 and other=68.8%, P<0.001). Long-term success predictors were DG (OR, 5.113; 95% CI, 1.643-5.981; P=0.035), early diagnosis (OR, 2.455; 95% CI, 1.129-3.522; P=0.042), nausea/vomiting (OR, 3.541; 95% CI, 1.881-5.511; P=0.012), GCSI (1.5-2) and RP4H<10% at 6 months (OR, 3.612; 95% CI, 2.122-5.317; P=0.022 and OR, 2.188; 95% CI, 1.435-4.233; P=0.039, respectively).G-POEM is an effective 4-year treatment in patients with RG, especially, in DG, posing a potential first-line therapy in these patients. However, randomized, controlled clinical trials are needed to confirm these results.