Short-term and Long-term Efficacy of Gastric Peroral Endoscopic Myotomy for Refractory Gastroparesis: A Meta-analysis.

[BACKGROUND] Gastric peroral endoscopic myotomy (G-POEM) is an emerging endoscopic approach to treat refractory gastroparesis (GP). Previous studies have shown short-term benefits, but the long-term outcomes are unclear. This analysis evaluated the short- and long-term efficacy of G-POEM compared with standard medical treatment for adults with refractory GP.

[METHODS] We performed a systematic review and meta-analysis of studies that evaluated G-POEM for refractory GP. Clinical success was defined variably across studies, most commonly as a ≥50% reduction in Gastroparesis Cardinal Symptom Index (GCSI) scores or combined symptoms and gastric emptying improvement. Pooled estimates for clinical success, GCSI scores, and gastric emptying scintigraphy (GES) were calculated using a random effects model. Adverse events and predictors of long-term outcomes were assessed.

[RESULTS] This meta-analysis included 23 studies involving 871 patients who underwent G-POEM. The clinical response rates remained consistently above 70% during the first year, peaked at 79% at 24 months, and reached 81% at 60 months. G-POEM was associated with significant and durable reductions in GCSI scores at 1 month (SMD -2.68, 95% CI: -3.58 to -1.78), 12 months (SMD -2.12, 95% CI: -2.73 to -1.50), and 60 months (SMD -2.55, 95% CI: -4.88 to -0.23), as well as sustained improvements in gastric emptying at 12 months (SMD -33.60%, P <0.05) and 24 months (SMD -36.17%, P <0.05). Adverse events occurred in 7% of the cases. Predictors of long-term clinical success included idiopathic etiology (P=0.04), shorter disease duration (P=0.04), prior botulinum toxin injection (P=0.02), and higher baseline symptom severity (P <0.05).

[CONCLUSIONS] G-POEM may offer sustained symptoms and gastric emptying improvement in refractory GP, but findings should be interpreted cautiously given reliance on observational data, variable success definitions, lack of sham-controlled evidence, and the absence of a standard effective medical comparator. Careful patient selection remains essential, and randomized trials are needed to confirm its long-term efficacy.