Functional constipation is associated with long-term clinical failure after gastric per-oral endoscopic myotomy for the treatment of gastroparesis

Abstract

Background: This study investigates the role of functional constipation (FC) in predicting the long-term success of Gastric Per-oral Endoscopic Myotomy (G-POEM) for treating gastroparesis.

Methods: This was a retrospective observational study. Patients who underwent G-POEM between July 2015 and August 2022 with > 6-month follow-up were included. The primary objective was to evaluate the relationship between FC and G-POEM success. Secondary objectives included documenting the role of other digestive motility disorders, history of eating disorders, chronic opioid use, and cannabis use. Multivariate logistic regression analysis was used to evaluate the relationship between clinical success and various parameters, including FC.

Results: 80 patients were included, 58 women (72.5%) and 22 men (27.5%) with a mean age of 51.78 years. The mean follow-up was 3.4 years. Clinical success was observed in 52.5% of the patients' post-G-POEM. 42.5% had FC, 17.7% had esophageal motility disorders (EMD), and 13.9% had other motility disorders. In univariate analysis, FC and EMD were more frequent in patients with failure: 57.89 vs 28.57%, p = 0.015 and 28.95 vs 7.32%, p = 0.017, respectively. In multivariate analysis, the presence of FC (OR = 0.281 [0.105; 0.75], p = 0.0113) was the only predictive factor for success.

Conclusion: FC emerged as a significant predictor of lower clinical success rates after G-POEM. It suggests that an expanded gastrointestinal evaluation and treatment of other motility disorders may improve the outcomes for patients with gastroparesis treated with G-POEM.

Keywords: Endoscopy; Esophageal motility disorders; Functional constipation; Gastric per-oral endoscopic myotomy; Gastroparesis; Submucosal endoscopy.