Short-term and Long-term Efficacy of Gastric Peroral Endoscopic Myotomy for Refractory Gastroparesis

Background: Gastric peroral endoscopic myotomy (G-POEM) is an emerging endoscopic approach to treat refractory gastroparesis (GP). Previous studies have shown short-term benefits, but the long-term outcomes are unclear. This analysis evaluated the short- and long-term efficacy of G-POEM compared with standard medical treatment for adults with refractory GP. Methods: We performed a systematic review and meta-analysis of studies that evaluated G-POEM for refractory GP. Clinical success was defined variably across studies, most commonly as a ≥50% reduction in Gastroparesis Cardinal Symptom Index (GCSI) scores or combined symptoms and gastric emptying improvement. Pooled estimates for clinical success, GCSI scores, and gastric emptying scintigraphy (GES) were calculated using a random effects model. Adverse events and predictors of long-term outcomes were assessed. Results: This meta-analysis included 23 studies involving 871 patients who underwent G-POEM. The clinical response rates remained consistently above 70% during the first year, peaked at 79% at 24 months, and reached 81% at 60 months. G-POEM was associated with significant and durable reductions in GCSI scores at 1 month (SMD −2.68, 95% CI: −3.58 to −1.78), 12 months (SMD −2.12, 95% CI: −2.73 to −1.50), and 60 months (SMD −2.55, 95% CI: −4.88 to −0.23), as well as sustained improvements in gastric emptying at 12 months (SMD −33.60%, P <0.05) and 24 months (SMD −36.17%, P <0.05). Adverse events occurred in 7% of the cases. Predictors of long-term clinical success included idiopathic etiology ( P =0.04), shorter disease duration ( P =0.04), prior botulinum toxin injection ( P =0.02), and higher baseline symptom severity ( P <0.05). Conclusions: G-POEM may offer sustained symptoms and gastric emptying improvement in refractory GP, but findings should be interpreted cautiously given reliance on observational data, variable success definitions, lack of sham-controlled evidence, and the absence of a standard effective medical comparator. Careful patient selection remains essential, and randomized trials are needed to confirm its long-term efficacy.