Redefining the Treatment Landscape in Gastroparesis: A Clinical Review of Gastric Peroral Endoscopic Myotomy Outcomes and Therapeutic Integration.

Gastroparesis is a chronic gastric motility disorder marked by delayed gastric emptying in the absence of mechanical obstruction. For patients with symptoms refractory to medical and dietary therapy, Gastric Peroral Endoscopic Myotomy (G-POEM) has emerged as a minimally invasive, pylorus-targeted intervention that directly addresses pyloric dysfunction. Technical success rates consistently exceed 95%, reflecting procedural standardization and a favorable learning curve. Short-term symptom improvement is reported in up to 80% of patients and is often accompanied by enhanced gastric emptying and quality of life (QOL). Long-term outcomes show sustained clinical success of 50%-77.5% at 3-4 years, influenced by disease etiology and neuromuscular progression. Endoluminal functional lumen imaging probe, a functional imaging tool that measures pyloric distensibility, has shown promise in identifying optimal candidates and assessing procedural efficacy, though standardized predictive thresholds are still lacking. Overall, G-POEM has become a leading pylorus-directed therapy for refractory gastroparesis. Comparative data suggest that G-POEM offers superior clinical efficacy and durability relative to botulinum toxin injection and gastric electrical stimulation, with fewer complications than surgical pyloroplasty. This review integrates the current clinical evidence supporting G-POEM, with a focus on patient selection, procedural outcomes, QOL, and durability of response. It also examines comparative data with alternative therapies and addresses ongoing areas of controversy, including procedural technique, repeat intervention, and the predictive value of prior pyloric-directed therapies. G-POEM represents a safe and effective treatment modality for appropriately selected patients and continues to shape the landscape of gastroparesis management.