Outcomes and Quality of Life Assessment After Gastric Per Oral Endoscopic Pyloromyotomy (G-POEM): 2016 ACG Governors Award for Excellence in Clinical Research

Introduction: Gastric Per oral endoscopic pyloromyotomy (G-POEM) is emerging as an option for treatment of refractory gastroparesis. The purpose of this study is to assess outcomes and improvement in quality of life after G-POEM. Methods: We performed a retrospective review of data for patients who underwent G-POEM. All pertinent pre-procedural data, procedural data and follow up data were abstracted. Clinical success was defined by improvement in clinical symptoms measured by a decrease in GCSI and no recurrent hospitalization. Normally distributed data were analyzed using a paired t test. SF-36 was expressed as medians and analyzed using the Wilcoxon signed-rank test. A p value less than 0.05 was considered statistically different. Results: A total of ten patients with refractory gastroparesis underwent the procedure (diabetic in four patients (40%), idiopathic in four patients (40%), one post infectious (10%) and one post surgical (10%) at our institution. Of these, 8 were female (80%) and 2 were male patients (20%). Four patients were African American (40%) and six patients were Caucasian (60%). Mean age was 47.3+/- 17.3 years. G-POEM was successfully performed in all ten patients. Mean duration of procedure was 47.7+/-20.1 minutes. Mean myotomy length was 2.94+/-0.1 cm. Mean length of hospital stay was 2.5 +/-0.9 days. No adverse events occurred with G-POEM. The procedure was clinically successful in eight out of ten patients (80%) during a mean follow up of 4.6 months+/-4.1 months (range 1-12) with a decrease in mean Gastroparesis Cardinal Score Index (GCSI) from 30.1+/-4.6 prior to the procedure to 12.8+/-8.7 (p=0.0001) at follow up. Post G-POEM gastric emptying study (GES) was obtained on 7 patients (normalized in 5 patients and improved in 2 patients) Mean 4-hour gastric retention on GES decreased from 62.5% +/- 24.4 to 25.4% +/-19.3 (p=0.009) after G-POEM. One patient had no response and required hospitalization for nausea and vomiting 15 days after G-POEM, and one patient did not have improvement in her symptoms. SF-36 questionnaire demonstrated a significant improvement in quality of life in several domains during follow up (Figure 1)Figure 1Conclusion: This study demonstrates promising short-term outcomes after G-POEM for gastroparesis with significant relief of symptoms in most, not all patients, measured by an improvement in GCSI score, reduced gastric retention percentages on 4 hour GES and significant improvement in several domains of the quality of life assessment.