Gastric peroral pyloromyotomy effectiveness in management of all types of gastroparesis

Background

Gastric peroral pyloromyotomy (G-POP) is a minimally invasive endoscopic technique for treating refractory gastroparesis (GP). The functional luminal imaging probe (FLIP) is an endoscopic tool for measuring the physiologic parameters of the gastrointestinal sphincters. Here, FLIP was used to investigate the association between physiologic measurements of the pylorus and clinical outcomes after G-POP using the Gastroparesis Cardinal Symptom Index (GCSI) to monitor clinical response.

Methods

This was a single-center prospective study of 48 patients with GP who underwent G-POP for the management of refractory GP. The cross-sectional area, pressure, and distensibility index (DI) of the pylorus were evaluated using FLIP at 40-mL and 50-mL balloon fill volumes pre- and postprocedurally. GCSI scores were used to monitor clinical symptoms both preprocedurally and at 6 weeks after G-POP.

Results

Technical success was achieved in 100% of patients. GCSI scores (0−5) decreased by an average of 0.95 ± 1.45 points at 6 weeks postoperatively, with the nausea/vomiting and bloating subscales showing the greatest improvement. The change (∆) in DI at 50-mL balloon fill volumes was a statistically significant predictor of symptomatic improvement after the procedure, with ∆DI at 50 mL of >1.5 mm²/mm Hg strongly correlated with larger improvements in GCSI (Pearson coefficient: 0.544; P =.036).

Conclusion

The EndoFLIP was not found to be a reliable predictor of clinical success before G-POP. However, measuring changes pre- and postprocedurally can be used to guide management. Additional investigations are needed to elucidate the relationship between physiologic pyloric sphincter measurements and clinical response to G-POP.