BACKGROUND & AIMS: Gastric peroral endoscopic myotomy (G-POEM) is an emerging treatment for gastroparesis, but clinical outcomes can be inconsistent; hence, it is vital to enhance our management strategies for patients with clinical failure. METHODS: This was a multicenter retrospective review of patients who underwent G-POEM for refractory gastroparesis from September 2015 to November 2023. Clinical outcomes and management post-G-POEM were assessed and categorized into 4 types based on symptom improvement and gastric emptying metrics. RESULTS: Of the 482 patients, 221 (46%) underwent evaluations with pre- and post-G-POEM gastric emptying tests and were included in the study. Type 1 clinical response (clinical success with improved gastric emptying scintigraphy [GES]) was the most common outcome, occurring in 56%. This was followed by type 4 (clinical failure with no GES improvement) at 23%, type 2 (clinical failure with improved GES) at 15%, and type 3 (clinical success with no GES improvement) at 6.7%. Patients with primary clinical failure (types 2 and 4) showed significantly higher daily opioid use at 23%, compared with 7% in types 1 and 3 (P = .032). Clinical failure overall was observed in 60% during a median follow-up of 48 months, with 31% managed by pylorus-directed retreatment and 7% with gastric neurostimulator placement. In the type 1 response group, clinical success was re-established in 71% following pylorus-directed therapies, with repeat G-POEM being an independent predictor of clinical success post-re-treatment (odds ratio, 2.2; P = .02). CONCLUSION: Our study highlights the importance of post-G-POEM GES assessments for characterizing clinical responses. Type 1 responders are more likely to benefit from subsequent pylorus-directed re-treatments, particularly repeat G-POEM interventions. CLINICALTRIALS: gov, Number: NCT04434781.

Division of Gastroenterology and Hepatology Indiana University School of Medicine Indianapolis Indiana

Division of Gastroenterology and Hepatology Indiana University School of Medicine Indianapolis Indiana; The University of Jordan School of Medicine Amman Jordan

Division of Gastroenterology and Hepatology Institute for Clinical and Experimental Medicine Prague Czech Republic

Division of Gastroenterology and Hepatology NorthShore University HealthSystem Evanston Illinois

Division of Gastroenterology and Hepatology Sharp HealthCare San Diego California

Division of Gastroenterology and Hepatology Stanford University Stanford California

Division of Gastroenterology and Hepatology Thomas Jefferson University Philadelphia Pennsylvania

Division of Gastroenterology and Hepatology University of Kansas Lawrence Kansas

Division of Gastroenterology and Hepatology University of Virginia Medical Center Charlottesville Virginia

Division of Gastroenterology and Hepatology Vanderbilt University Nashville Tennessee

Division of Gastroenterology and Hepatology Vanderbilt University Nashville Tennessee; Division of Gastroenterology and Hepatology The University of Texas Medical Branch Galveston Texas

Division of Thoracic Surgery University of Mississippi Medical Center Jackson Mississippi

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ClinicalTrials.gov
NCT04434781