Background : Gastric peroral endoscopic myotomy (G-POEM) has shown promising results in improving gastroparesis (GP) symptoms and quality-of-life (QoL). However, a proportion of patients either fail to respond to initial G-POEM or later experience symptom recurrence after an initial period of improvement. G-POEM revision has been proposed as a management option, but data regarding its safety and feasibility remain limited. Methods : Prospectively enrolled patients who underwent initial G-POEM followed by a G-POEM revision at a single high-volume institution were included. Evaluations were conducted at baseline and at 6 months after both the initial procedure and the revision. Validated tools were used to assess outcomes, including the Gastroparesis Cardinal Symptom Index (GCSI), the Patient Assessment of Gastrointestinal Disorders Symptom Severity Index (PAGI-SYM), and the 36-Item Short Form Survey (SF-36). Additionally, results of 4-hour solid-phase gastric emptying scans (GES) were recorded. Clinical success was defined as improvement in GCSI scores by ≥ 1 point after G-POEM revision compared to the baseline prior to the initial G-POEM. Results : Fourteen patients were included. The mean total GCSI score improved from 3.5 (± 0.8) at baseline prior to initial G-POEM to 2.4 (± 1.5) at 6 months after G-POEM revision (P = 0.047). The average PAGI-SYM total score significantly improved from 3.2 (± 0.9) at baseline to 2.2 (± 1.3) at 6 months after revision (P = 0.008). The mean SF-36 QoL total score and the mean 4-hour gastric retention on GES demonstrated improvement trends but did not reach statistical significance. Clinical success was achieved in 50.0% of patients who underwent G-POEM revision. No adverse events were reported. Conclusion : G-POEM revision resulted in meaningful symptom improvement for GP patients with primary failure or recurrent symptoms after initial G-POEM, without associated adverse events. Further studies are needed to better characterize patient phenotypes most likely to benefit from revision G-POEM.
Hadaki et al. (Fri,) studied this question.