Noppachai Siranart, MD1, Daniel Martin Simadibrata, MD2, Chanattha Thimphitthaya, MD3, Panisara Fangsaard, MD4, Patavee Pajareya, MD5, Akaravit Thamthanaruk, MD5, Vanit Nokkhuntong, MD5, Natchaya Polpichai, MD6, Emily Shu-Yen Chan, MD, MSc6, Somkiat Phutinart, 7 1Brigham and Women's Hospital, Boston, MA; 2Case Western Reserve University / MetroHealth, Cleveland, OH; 3University of Texas Southwestern Medical Center, Dallas, TX; 4Bassett Medical Center, Cooperstown, NY; 5King Chulalongkorn Memorial Hospital, Bangkok, Krung Thep, Thailand; 6Weiss Memorial Hospital, Chicago, IL; 7Chulalongkorn University, Bangkok, Krung Thep, Thailand
Introduction: Gastric Peroral Endoscopic Myotomy (G-POEM), gastric electrical stimulation (GES), and combination therapy, have shown great efficacy for the treatment of gastroparesis that is refractory to medications. This study aims to compare the efficacy and safety of these new approaches with conventional surgical interventions.
Methods: A literature search was performed up until May 2024 to identify studies that compared various techniques, including G-POEM, GES, Botulinum injection, surgical interventions (pyloroplasty / pyloromyotomy/ gastrectomy / Roux-en-Y gastric bypass (RYGB)) compared to placebo in patients with refractory gastroparesis. Primary endpoints were success rate and adverse events. Secondary endpoints were improvements in gastroparesis cardinal symptom index (GCSI) total score, gastric emptying scintigraphy test (GET) at 4 hours and length of hospital stay. A random-effects model of network meta-analysis, along with p-scores was employed to assess and rank the treatments for the different outcomes.
Results: Out of 4605 articles identified in the database, 17 articles were eligible with a total of 1598 patients. For clinical success, GES combined with surgical pyloromyotomy/ pyloroplasty ranked first among other endoscopic and/or surgical interventions, followed by RYGB and G-POEM with P-score of 0.751, 0.638, and 0.613, respectively. For improvement in GCSI score, GES combined with G-POEM ranked first, followed by surgical pyloric procedure and G-POEM alone (P-score of 0.697, 0.659, and 0.617, respectively), while for change in GET at 4 hours, GES + G-POEM ranked first, followed by Botulinum toxin injection, and G-POEM alone (P-score of 0.599, 0.580, and 0.539, respectively). GES ranked first for the shortest length of stay, while surgical pyloroplasty ranked last (P-score of 0.964 and 0.061 respectively). Botulinum toxin injection, G-POEM and surgical pyloroplasty had lower risks of adverse events, while GES + G-POEM presented moderate adverse event risks.
Discussion: Combination procedures including GES showed the highest clinical success, GCSI score improvement, and change in GET at 4 hours. This study warrants the potential benefits of combination therapy in improving outcomes in gastroparesis patients.
Figure: (A) Network plot for clinical success (B) Network plot for adverse events (C) Relative Rankings for Clinical Success and Adverse Events
Disclosures:
Noppachai Siranart indicated no relevant financial relationships.
Daniel Martin Simadibrata indicated no relevant financial relationships.
Chanattha Thimphitthaya indicated no relevant financial relationships.
Panisara Fangsaard indicated no relevant financial relationships.
Patavee Pajareya indicated no relevant financial relationships.
Akaravit Thamthanaruk indicated no relevant financial relationships.
Vanit Nokkhuntong indicated no relevant financial relationships.
Natchaya Polpichai indicated no relevant financial relationships.
Emily Shu-Yen Chan indicated no relevant financial relationships.
Somkiat Phutinart indicated no relevant financial relationships.
Noppachai Siranart, MD1, Daniel Martin Simadibrata, MD2, Chanattha Thimphitthaya, MD3, Panisara Fangsaard, MD4, Patavee Pajareya, MD5, Akaravit Thamthanaruk, MD5, Vanit Nokkhuntong, MD5, Natchaya Polpichai, MD6, Emily Shu-Yen Chan, MD, MSc6, Somkiat Phutinart, 7. P5055 - New Endoscopic Approaches Versus Conventional Surgical Interventions in the Management of Refractory Gastroparesis: A Network Meta-Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
