Gastric per-Oral Endoscopic Myotomy for Refractory Gastroparesis: A Meta-Analysis

The emerging gastric per-oral endoscopic myotomy (G-POEM) is becoming an alternative treatment method for gastroparesis. This study aimed to evaluate the feasibility and safety of G-POEM for gastroparesis. Relevant publications were identified through searching PubMed, EMBASE, Cochrane Library, and Web of Science before April 1, 2019. Studies presenting the clinical data of G-POEM for the treatment of gastroparesis were included. Data about effectiveness and safety were extracted, pooled, and analyzed. Forest plots were graphed based on random effects models. A total of 272 patients representing 8 studies were eligible for analysis. The pooled rates of GCSI at preprocedure, 1–3 months, 6 months, and 12 months, were 3.25 (95% CI, 2.75–3.75), 1.80 (95% CI, 1.10–2.49), 1.56 (95% CI, 0.45–2.68), and 1.10 (95% CI, 0.75–1.45), respectively. The pooled results of 4-h GES pre- and post-G-POEM were 41.89% (95% CI, 32.75–51.03%) and 16.48% (95% CI, 9.83–23.14%), respectively. Furthermore, the pooled clinical response rate was 84% (95% CI, 77–89%). The GES improvement rate and GES normal rate were also analyzed, and the results were 84% (95% CI, 77–90%) and 53% (95% CI, 39–66%), respectively. Finally, the pooled adverse events rate was 12% (95% CI, 6–19%). G-POEM was shown to be feasible and safe for the treatment of gastroparesis with various etiologies, which could be a potential first-line therapy for certain patients. Future studies are needed to investigate the appropriate patients for G-POEM to explore the “most beneficial” subgroup of patients.