Copyright ©The Author(s) 2019.
World J Gastroenterol. Feb 28, 2019; 25(8): 909-922
Published online Feb 28, 2019. doi: 10.3748/wjg.v25.i8.909
Table 1 Clinical outcomes of per oral endoscopic pyloromyotomy
TypeNEtiology of gastroparesisDefinition of refractory gastroparesisAverage Procedure duration (min)Outcome measurementClinical response definitionClinical response rate N (%)GCSI improvementSubscaleAdverse eventFollow-up period (mo) (Additional treatment during follow up)
Shlomovitz et al[37]Retrospective72 PSG; 4 IG; 1 patient with normal GESNot defined90-120GES (3M) ; Gastroparesis; SymptomsSymptomatic improvement85.7%NANausea and epigastric burn significantly improvedOne prelyloric ulcer with GI bleed6.5 (2-11) (1 patient required Laparoscopic pyloroplasty at 7 mo, also no response after the procedure)
Chung et al[41]Retrospective84 DG; 4 PSGNot definedGOOSS; GESNANANANausea; Vomiting; Abdominal pain1 bleeding pre-pyloric ulcer; 1 dumping syndome7
Khashab et al[45]1Retrospective3011 DG; 12 PSG; 7 IGPresence of symptoms despite dietary; Modification and treatment with prokinetics and antiemetics72 ± 42GES (3M); Gastroparesis Symptoms (Graded self-reported symptomatic responses: Resolved, improved, unchanged or worse)Reduction in gastroparesis symptoms with absence of recurrent hospitalization86%NA97% improve nausea; 63% improve in vomiting; 73% improve in abd pain; 93% maintain or gain weight6.7% 1 capnoperitonum; 1 prepyloric ulcer5.5
Gonzalez et al[2] FranceRetrospective297 DG 5 PSG; 15 IG; 2 Other (Scleroderma)Symptoms > 6 mo despite Rx and fail “all” prokinetic drug, GCSI > 1.547GES (2M); GCSIImprovement in GCSI and GES79% (3M); 69% (6M)3.3 to 1.1All GCSI5 pneumoperitoneum; 2 Bleeding; 1 perigastric abscess (patient ate 2 h post-procedure) 1 delayed pre-pyloric stricture6
Dacha et al[43]Retrospective169 DG; 1 PSG; 5 IG; 1 PIGPatients who failed to respond to dietary modification, prokinetic medication, or electrical stimulator49.7 ± 22.1GES; GCSI; SF36A decrease in mean GCSI with an improvement of at least 2 subsets of cardinal symptoms and no gastroparesis -related hospitalization81%3.4 to 1.5N/V and early satiety significantly improved but not bloatingnone12
Rodriguez et al[48]Prospective observation4712 DG; 8 PSG; 27 IGPatients with ongoing symptoms after at least 6 mo of medical therapy41.2 ± 28.5GES; GCSIimprovement in post-procedure GCSI, a decrease in the total number of gastroparesis medications used, and improved GES at 90-dayNot reported3.6 to 3.3All 3 subscales were significantly improved but N/V and bloating improved the mostnone3 (1 pt had lap total gastrectomy at 9 mo)
Allemang et al[55]Retrospective57Not reportedNot clearly defined41GCSIImproved GCSINot reported4.6 to 3.3Not reportedNot reported3
Malik et al[47]Case series131 DG; 8 PSG; 4 IGNot clearly defined± 23GES; PAGI-SYM; EndoFLIPImproved GCSI, CPGAS, and GES72.7%2.1 to 1.9Vomiting, retching, and loss of appetite improved the most by 29, 24, and 24%. None was statistically significant; Abd distension was actually worse1 pulm embolism3
Mekaroonkamol et al[62]Retrospective3012 DG; 5 PSG; 12 IG; 1 PIGPatients who failed to respond or could not tolerate to dietary modification, prokinetic medication, or electrical stimulator48.3 ± 16.5GES (2M); GCSI; SF36; ER visit rate; Hospitalization rateDecrease in at least 1 averaged point of GCSI with more than a 25% decrease in at least 2 subscales > 25% increase in the mean SF-36 score with at least 50% increase in 3 categories83.3%3.6 to 1.4Nausea and early satiety significantly improved; Pain only improved up to 6 mo but not thereafter1 tension capnoperitoneum (3.3%)18
Jacques et al[61]Prospective2010 DG; 1 PSG; 4 IG; 5 Other (including 3 Sjogen, 1 Parkinson’s, and 1 systemic sclerosisSymptoms > 6 mo despite medication, GCSI > 2.6 OR refractory vomiting, uncontrolled post-prandial hypoglycemia, need for oral medication, Fail at least 2 out of 3 prokinetic drug56.5GES (3M); GCSI; PAGI-QoL; GIQLI; EndoFlIP; Abdominal pain scoreA decrease of more than 0.75 point of GCSI90%3.5 to 1.3All 9 subscale of GCSI except for retching4 perforation, including 1 required surgical intervention1 case of epitaxis3
Kahaleh et al[58]2Retrospective337 DG; 12 PSG; 13 IG; 1 OtherNot clearly defined77.6 (37-255)GES; GCSIImprovement in GCSI and GES85%3.3 to 0.8All subscale including abd pain significantly improved1 bleeding and 1 ulcer11.5
Hustak et al[59]2Prospective72 DG; 4 PSG; 1 IGNot clearly defined70GES; GCSIImprovement in GCSI of > 40% and GES100%3.26 to 1.24Not reported1 bleeding ulcer12
Mekaroonkamol et al[62]2Retrospective4015 DG; 5 PSG; 18 IG; 1 PIG; 1 Other (Ehlers Danlos)Patients who failed to respond or could not tolerate to dietary modification, prokinetic medication, or electrical stimulatorNot reportedGES (2M); GCSI; SF36Decrease in at least 1 averaged point of GCSI with more than a 25% decrease in at least 2 subscalesNot reported3.6 to 1.9Only nausea/vomiting and early satiety improved, but not for bloating1 capnoperiteum; 1 COPD exacerbation; 1 myotomy dehiscence18