Gastric peroral endoscopic myotomy versus surgical pyloromyotomy/pyloroplasty for refractory gastroparesis: systematic review and meta-analysis

Abstract

Background and study aims Gastric per-oral endoscopic myotomy (G-POEM) has been recently compared with surgical techniques (i. e. pyloromyotomy and pyloroplasty) for managing patients with refractory gastroparesis. Given the varying results, we performed a systematic review and meta-analysis of available studies to assess the safety and efficacy of each technique. Patients and methods A comprehensive review of the literature using the following databases was undertaken through July 29, 2022: MEDLINE, Embase, Web of Science, KCI - Koran Journal index, Global Index Medicus, and Cochrane. Comparative studies including case-control, cohort and randomized controlled trials (RCTs) were included. Random effects model using DerSimonian laird approach was used to compare outcomes. Relative risk (RR) and mean difference (MD) were calculated for binary and continuous outcomes respectively. Results A total of four studies with 385 patients (216 in the G-POEM group and 169 in the surgical group were included. The mean age was 46.9 (± 3.41) and 46.2 (± 0.86) and the female proportion was 79.6 % and 74.0 % for the G-POEM and surgery group respectively. The mean procedural time (MD: -59.47 mins, P < 0.001) and length of hospital stay (MD: -3.10 days, P < 0.001) was significantly lower for G-POEM compared to surgery. The post procedure GCSI score (MD: -0.33, P = 0.39) and reduction in GCSI score preoperatively and postoperatively (MD: 0.27, P = 0.55) was not significantly different. Conclusions G-POEM appears promising as it may provide a cost-effective approach for managing refractory gastroparesis compared to surgical techniques. RCTs are needed to further confirm these results.

Fig. 1

PRISMA flow diagram (G-POEM: Gastric per-oral endoscopic myotomy). From: Page MJ, McKenzie JE, Bossuyt PM et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372: n71.

Fig. 2

Mean difference for a procedure duration, b LOS, c postoperative GCSI, d preoperative/postoperative difference in GCSI between G-POEM and surgical group. CI, confidence interval; LOS, length of stay.

Fig. 3

Odds ratio for a clinical success, b normal GES, c reintervention rate, d readmission rate, and e any complication rates between G-POEM and surgical group. CI, confidence interval.