Endoscopic Peroral Pyloromyotomy vs Laparoscopic Gastric Electrical Stimulator for Gastroparesis: A Propensity Score-Matched Multicenter Trial

Abstract

Background: Medically refractory gastroparesis is a debilitating motility disorder that impairs patient well-being. Although endoscopic and surgical interventions are available, therapy selection remains controversial. Here, we present a propensity score-matched, multi-institutional analysis comparing outcomes of endoscopic peroral pyloromyotomy (POP or gastric peroral endoscopic myotomy [G-POEM]) and laparoscopic gastric electrical stimulator (GES) for gastroparesis.

Study design: Patients who underwent POP/G-POEM or GES at 2 high-volume centers from January 2001 to May 2024 were retrospectively reviewed. Propensity scoring, based on age, sex, and gastroparesis cause, was performed in a 1:1 ratio for patients (n = 226) undergoing GES and POP/G-POEM. Two-tailed, unpaired t -test with unequal variance and Fisher's exact test were used to analyze perioperative outcomes. Symptom improvement was evaluated using the Gastroparesis Cardinal Symptom Index and subjective reporting. Perioperative outcomes, BMI changes, recurrence, and need for additional interventions were used to compare the safety and efficacy of the 2 procedures.

Results: Mean operative time (95.6 vs 28.9 minutes, p < 0.001), estimated blood loss (10.9 vs 2.75 mL, p < 0.001), and length of stay (2.4 vs 0.5 days, p < 0.001) were reduced in patients who underwent POP/G-POEM vs GES. Ninety GES patients reported varied postoperative symptom improvement (mild, n = 27; moderate, n = 23; significant, n = 37; complete resolution, n = 1; none, n = 23), whereas POP/G-POEM patients showed a 37.2% reduction in Gastroparesis Cardinal Symptom Index (1.2 units, p < 0.001). Both procedures had similar rates of immediate complications, 1-year reintervention, and 1-year BMI increase (POP/G-POEM: 0.48 ± 2.7; GES: 0.46 ± 2.3, p > 0.96); however, POP/G-POEM demonstrated a lower symptom recurrence rate (78.8% vs 41.6%, p < 0.001).

Conclusions: Compared with GES, POP/G-POEM is less morbid and more effective, suggesting it should be offered first for treating medically refractory gastroparesis.