Gastric Per Oral Pyloromyotomy (GPOP) is Effective Management of All Types of Gastroparesis.

Abstract

Background: Gastric peroral pyloromyotomy (G-POP) is a minimally invasive endoscopic technique for the treatment of refractory gastroparesis. Functional luminal imaging probe (FLIP) is an endoscopic tool that measures physiologic parameters of GI sphincters. In this study, FLIP was employed to investigate the association between physiologic measurements of the pylorus with clinical outcomes following G-POP using the Gastroparesis Cardinal Symptom Index (GCSI) to monitor clinical response.

Methods: This is a single-center prospective study of forty-eight gastroparetic patients who underwent G-POP for management of refractory gastroparesis. Cross-sectional area (CSA), pressure, and the distensibility index (DI) of the pylorus were evaluated with FLIP at 40mL and 50mL balloon fill volumes pre- and post-procedurally. GCSI scores were used to monitor clinical symptoms both pre-procedurally and at 6-weeks post-G-POP.

Results: Technical success was achieved in 100% of patients. GCSI scores (0-5) decreased by an average of 0.95 +/- 1.45 points at 6 weeks post-op, with the Nausea/Vomiting and Bloating subscales showing the greatest improvement. The change in DI at 50-mL balloon fill volumes was a statistically significant predictor of symptomatic improvement following the procedure, with ∆DI @ 50mL > 1.5mmHg/mm2 strongly correlated with larger improvements in GCSI (Pearson coefficient 0.544, p = 0.036).

Conclusions: EndoFLIP was not found to be a reliable predictor of clinical success prior to G-POP, however measuring changes pre- and post-procedurally can be used to guide management. Additional investigations are needed to elucidate the relationship between physiologic pyloric sphincter measurements and clinical response to G-POP.