Pyloric drainage interventions for gastroparesis: a comparison of laparoscopic pyloroplasty and gastric peroral endoscopic myotomy (G-POEM) outcomes.

Abstract

Background: The endoscopic approach to the surgical management of gastroparesis is gaining popularity. However, data comparing endoscopic myotomy to traditional laparoscopic pyloroplasty are limited. This study aimed to compare outcomes between gastric-per-oral endoscopic myotomy (G-POEM) and pyloroplasty.

Methods: Gastroparesis patients who underwent pyloroplasty or G-POEM from 2013 through 2023 at our institution were reviewed. Pre/postoperative gastroparesis cardinal symptom index (GCSI), resolution of the predominant gastroparesis symptom, and gastric emptying scintigraphy (GES) were assessed.

Results: There were 314 patients who underwent surgical myotomy. Median (IQR) age was 51.9 (40-62) and 84.1% were female. Of these 81 underwent G-POEM and 233 underwent pyloroplasty. Age and sex were similar between surgical approaches (p > 0.05). Gastroparesis etiology was 61.8% idiopathic, 21.3% diabetic, and 16.9% postsurgical. Postsurgical etiology was more likely to undergo G-POEM (25.9% vs. 13.7%, p = 0.046). At a mean (SD) of 14.2(17) months resolution of the predominant gastroparesis symptom was achieved by 70.0% after G-POEM and 76.4% after pyloroplasty (p = 0.297). The GCSI improved after G-POEM [3.1(2-4) to 2.4 (2-3), p = 0.0498] and pyloroplasty [3.1(3-4) to 2.4(2-3), p < 0.0001]. There was no difference in postoperative GCSI (p = 0.805) or percent GCSI improvement (p = 0.976) between groups. In the 96 patients with pre- and postoperative GES, 4 h retention decreased for pyloroplasty from 29.0% (18-43) to 4.2% (1.0-18) (p < 0.0001) and for G-POEM from 23.0 (13-49) to 13 (5.0-29), (p = 0.045). Pyloroplasty showed a trend towards better emptying (p = 0.0719) with more patients achieving ≥ 50% improvement (70.3% vs. 50%, p = 0.086).

Conclusions: Gastroparesis symptom improvement was similar after pyloroplasty and G-POEM; however, there was a trend towards better improvement in gastric emptying after pyloroplasty.