Efficacy and Safety of Gastric Peroral Endoscopic Myotomy Across Different Etiologies of Gastroparesis: A Systematic Review and Meta-Analysis.

ABSTRACT

BACKGROUND AND AIMS: Gastric Peroral Endoscopic Myotomy (G-POEM) is an emerging treatment for refractory gastroparesis. While its efficacy and safety have been analyzed in previous systematic reviews and meta-analyses, no studies have compared its effectiveness based on etiology. Our study aims to evaluate the efficacy and safety of G-POEM by etiologies of gastroparesis. METHODS: We conducted a comprehensive search in major databases until October 2023, focusing on the efficacy and safety of G-POEM by etiology. Our primary outcome was clinical success based on etiology, with additional subgroup analysis on pre-and post-GCSI scores based on etiology using standard meta-analysis methods and the random-effects model. Heterogeneity was assessed using I2% statistics. RESULTS: In our analysis of 15 studies (7 retrospective, 8 prospective) involving 982 patients (mean age 50.81 years, mean follow-up 21 months), post-surgical conditions were the most common etiology in G-POEM (290 cases), followed by idiopathic factors (287 cases) and diabetes (286 cases). Subgroup analysis revealed pooled clinical success rates of 65% (CI 51-77; I2 = 46%) for diabetes, 70% (CI 46-86; I2 = 73%) for post-surgical, and 60% (CI 41-77; I2 = 68%) for idiopathic etiologies. Our research also indicated that G-POEM significantly improved GCSI scores 1.7 (95% CI -0.01 to 3.5, p = 0.052) for diabetes, 1.34 (95% CI -0.07 to 2.62, p = 0.038) for post-surgical, and 1.5 (95% CI 0.36 to 2.75, p = 0.01) for idiopathic patients. CONCLUSION: Based on this meta-analysis, G-POEM is effective and safe for treating refractory gastroparesis irrespective of the etiology, with significant improvements in clinical success rates and GCSI scores.