Abstract
Gastric per-oral endoscopic myotomy (G-POEM) has emerged as a potential therapy for patients
with medically refractory gastroparesis. While adequate patient selection is crucial, there is a
paucity of data on factors that may help select patients and predict a favorable response to G-POEM.
We performed a systematic review and meta-analysis to evaluate pyloric functional luminal imaging probe (FLIP) changes in patients undergoing G-POEM. Pre- and post-G-POEM data were collected and analyzed. Clinical response was defined as an improvement of at least 1 point in the mean overall Gastroparesis Cardinal Symptom Index (GCSI) score, consistent with criteria used across included studies. Standardized mean differences (SMD) compared metrics between groups (responders vs non-responders), and pooled success rates with 95% confidence intervals (CI) were estimated with random-effects models, with heterogeneity assessed by I2.
Four studies involving 203 patients (76.7% women, mean age 55.2 years), were included in the final analysis. Overall pooled clinical success and failure rates were 70.3% (CI 63.5-76.3; I2 0%) and 31.3% (CI 25.3-38.3; I2 0%), respectively. There were no differences between the responders vs. non-responders in baseline pyloric FLIP measurements. We found a statistically significant increase in the distensibility index (DI) following G-POEM in both groups. Conversely, pylorus cross- sectional area (CSA) only improved significantly among responders, 183.1 mm2 (163.8-202.5) vs 146.9 mm2 (125.1-168.8); SMD -0.71 (-0.99 to -0.43); P<0.001; I2=0% but not in non-responders following G-POEM.
Our analysis shows that patients who responded to G-POEM had higher baseline GCSI scores when compared to non-responders. Post-G- POEM pylorus CSA was associated with clinical response. FLIP may provide objective assessment of pyloric changes and be a potential tool to predict clinical outcome of G-POEM. Additional studies with standardized FLIP protocols in patients undergoing G-POEM are needed.