Redo rates and outcomes of gastric peroral endoscopic myotomy vs pyloroplasty for gastroparesis: a retrospective analysis.

BACKGROUND

Gastroparesis is a chronic gastrointestinal (GI) motility disorder that is defined by objectively delayed gastric emptying of solids in the absence of mechanical obstruction. Gastroparesis presents as a syndrome marked by a range of upper GI symptoms, most commonly nausea, vomiting, early satiety, bloating, belching, and upper abdominal discomfort or pain. Pylorus-targeting approaches have been a common management for gastroparesis, with gastric peroral endoscopic myotomy (G-POEM) and pyloroplasty being effective surgical options. However, comparative data on redo procedure rates and outcomes remain limited. This study aimed to compare the frequency, timing, and clinical outcomes of redo interventions after G-POEM vs pyloroplasty in patients with refractory gastroparesis, addressing the current gap in comparative data to help guide long-term procedural decision-making.

METHODS

A retrospective chart review was conducted on patients who underwent G-POEM or pyloroplasty from 2019 to 2024. Data included redo rates, time to reintervention, and postintervention outcomes. Statistical analyses were performed using appropriate tests for categorical and continuous variables.

RESULTS

Among 173 patients (85 who underwent G-POEM and 88 who underwent pyloroplasty), those who underwent pyloroplasty were more likely to have preoperative patient-reported esophageal reflux (P <.001) and concurrent procedures (P <.001). Of note, 42 patients (24%) required redo procedures (G-POEM: 52.4%; pyloroplasty: 47.6%). The mean time to redo was 383.18 days (P =.156). Although the reintervention rates were similar (P =.770), patients who underwent G-POEM more often underwent secondary pyloroplasty, whereas those who underwent pyloroplasty more frequently received gastric neurostimulators (P =.012). Symptom improvement was comparable (P =.870), with 51% reporting relief and 21% achieving resolution.

CONCLUSION

G-POEM and pyloroplasty have similar redo rates but differ in terms of the types of secondary intervention, highlighting the need for individualized treatment planning.