Malik Sheza, Loganathan Priyadarshini, Khan Khadeja, Mohan Babu P, Adler Douglas G
Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA.
Department of Internal Medicine, UT Health, San Antonio, Texas, USA.
Gastrointest Endosc. 2025 Jan;101(1):54-67.e6. doi: 10.1016/j.gie.2024.08.024. Epub 2024 Aug 23.
Gastric peroral endoscopic myotomy (G-POEM) is an emerging treatment for refractory gastroparesis. Although its efficacy and safety have been analyzed in previous systematic reviews and meta-analyses, no studies have compared its effectiveness based on etiology. Our study aims to evaluate the efficacy and safety of G-POEM by etiologies of gastroparesis.
We conducted a comprehensive search in major databases until October 2023, focusing on the efficacy and safety of G-POEM by etiology. Our primary outcome was clinical success based on etiology, with an additional subgroup analysis on Gastroparesis Cardinal Symptom Index (GCSI) scores before and after G-POEM based on etiology using standard meta-analysis methods and the random-effects model. Heterogeneity was assessed using I statistics.
In our analysis of 15 studies (7 retrospective, 8 prospective) involving 982 patients (mean patient age, 50.81 years; mean follow-up, 21 months), postsurgical conditions were the most common etiology in G-POEM (290 cases), followed by idiopathic factors (287 cases) and diabetes (286 cases). Subgroup analysis revealed pooled clinical success rates of 65% (95% confidence interval [CI], 51-77; I = 46%) for diabetes, 70% (95% CI, 46-86; I = 73%) for postsurgical conditions, and 60% (95% CI, 41-77; I = 68%) for idiopathic etiologies. Our research also indicated that G-POEM significantly improved GCSI scores: 1.7 (95% CI, -.01 to 3.5; P = .052) for diabetes, 1.34 (95% CI, -.07 to 2.62; P = .038) for postsurgical conditions, and 1.5 (95% CI, .36-2.75; P = .01) for idiopathic patients.
Based on this meta-analysis, G-POEM is effective and safe for treating refractory gastroparesis irrespective of the etiology, with significant improvements in clinical success rates and GCSI scores.
经口内镜下胃肌切开术（G-POEM）是一种新兴的难治性胃轻瘫治疗方法。尽管其疗效和安全性已在以往的系统评价和荟萃分析中得到分析，但尚无研究根据病因比较其有效性。我们的研究旨在根据胃轻瘫的病因评估G-POEM的疗效和安全性。
我们在主要数据库中进行了全面检索，直至2023年10月，重点关注G-POEM按病因分类的疗效和安全性。我们的主要结局是基于病因的临床成功，另外使用标准荟萃分析方法和随机效应模型，对基于病因的G-POEM前后的胃轻瘫主要症状指数（GCSI）评分进行亚组分析。使用I统计量评估异质性。
在我们对15项研究（其中7项回顾性研究，8项前瞻性研究）的分析中，涉及982例患者（患者平均年龄50.81岁；平均随访21个月），手术后情况是G-POEM中最常见的病因（290例），其次是特发性因素（287例）和糖尿病（286例）。亚组分析显示，糖尿病患者的汇总临床成功率为65%（95%置信区间[CI]，51-77；I=46%），手术后情况患者为70%（95%CI，46-86；I=73%），特发性病因患者为60%（95%CI，41-77；I=68%）。我们的研究还表明，G-POEM显著改善了GCSI评分：糖尿病患者改善1.7（95%CI，-0.01至3.5；P=0.052），手术后情况患者改善1.34（95%CI，-0.07至2.62；P=0.038），特发性患者改善1.5（95%CI，0.36-2.75；P=0.01）。
基于这项荟萃分析，无论病因如何G-POEM治疗难治性胃轻瘫都是有效且安全的，临床成功率和GCSI评分均有显著改善。
