First Description of Redo Gastric Per-Oral Endoscopic Myotomy for Refractory Gastroparesis: Technical Conduct and Outcomes.

Introduction

Gastroparesis is a progressive disease that may require endoscopic or surgical intervention, such as gastric per oral endoscopic myotomy (G-POEM), when conservative measures are ineffective or not tolerated. Limited data exist on redo G-POEM safety and effectiveness. We describe outcomes of patients undergoing repeat G-POEM for refractory gastroparesis.

Methods

A retrospective review of patients who underwent redo G-POEM at our center from 2008 to 2024. Data included demographics, gastroparesis etiology, previous treatments, Gastroparesis Cardinal Symptom Index (GCSI), gastric emptying studies (GES), and clinical outcomes.

Results

Three patients (mean age at first G-POEM 52.3 ± 19 years) were identified. All procedures were technically successful, and all 3 patients survived to discharge without major complications. Patient A (sarcoidosis-induced gastroparesis) had transient symptomatic improvement after the first G-POEM, but symptoms deteriorated the following year. GES showed initial improvement (26% to 14% 4-hour retention) but returned to baseline (26%) after the second G-POEM. She ultimately required jejunostomy tube placement. Patient B (idiopathic gastroparesis) with a history of renal transplant showed no objective improvement in GES after either procedure (40% to 41% 4-hour retention) and remained noncompliant with dietary recommendations. He died at age 35 from cardiac arrhythmia 2 years after the second G-POEM. Patient C (postsurgical gastroparesis) had improvement in GES after the first G-POEM (88% to 53% 4-hour retention) but then deteriorated to 73% despite symptomatic improvement. After symptom recurrence, redo G-POEM provided an excellent symptomatic response, but she remained total parenteral nutrition-dependent until death 4 years later.

Conclusion

While redo G-POEM is technically feasible and safe, our case series demonstrates poor long-term clinical outcomes across different gastroparesis etiologies. All 3 patients experienced treatment failure, with 2 requiring permanent nutritional support and 1 showing a lack of symptomatic response. These findings may suggest limited utility of redo G-POEM and highlight the need for careful patient selection.