Long‐term efficacy (at and beyond 1 year) of gastric peroral endoscopic myotomy for refractory gastroparesis: A systematic review and meta‐analysis
Francesco Vito Mandarino, Alberto Barchi, Noemi Salmeri, Francesco Azzolini, Ernesto Fasulo, Giuseppe Dell’Anna, Edoardo Vespa, Emanuele Sinagra, Jérémie Jacques, Silvio Danese
Abstract
Abstract Introduction Although gastric peroral endoscopic myotomy (G‐POEM) has shown substantial efficacy in patients with medically refractory gastroparesis (GP), comprehensive long‐term data on its effectiveness are lacking. Methods We conducted a systematic review and meta‐analysis including observational studies assessing long‐term efficacy after G‐POEM in patients with refractory GP. Our primary outcome was the pooled rate of clinical success 1‐year after G‐POEM. Secondary outcomes included clinical success at 2 and 3 years and the rate of adverse events according to the American Society for Gastrointestinal Endoscopy classification. Results Thirteen studies, involving 952 patients with refractory GP undergoing G‐POEM, were eligible. The pooled 1 year‐clinical success was 0.72 (95% confidence interval [CI]: 0.56, 0.85, I 2 = 94.9%). The clinical success was 0.67 (95% CI: 0.47, 0.97, I 2 = 95.8%) when considering only studies defining success as 1 point decrease in Gastroparesis Cardinal Symptoms Index score and at least 25% decrease in two subscales. For patients who had 1‐year success, the pooled clinical success at 2 and 3 years were 0.71 (95% CI: 0.45, 0.92, I 2 = 94.9%) and 0.58 (95% CI: 0.19, 0.92, I 2 = 97.1%), respectively. The pooled rate of adverse events was 0.08 (95% CI: 0.06, 0.10, I 2 = 0%). Conclusion G‐POEM is associated with successful outcomes in about 70% of treated cases after 1 year, with durable long‐term effects lasting up to 3 years. In the future, new uniform outcome definitions and strict patient selection criteria are warranted to delineate G‐POEM outcomes more accurately.