Mandarino Francesco Vito, Barchi Alberto, Salmeri Noemi, Azzolini Francesco, Fasulo Ernesto, Dell'Anna Giuseppe, Vespa Edoardo, Sinagra Emanuele, Jacques Jeremie, Danese Silvio
Division of Gastroenterology and Gastrointestinal Endoscopy IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University Milan Italy.
Gynecology/Obstetrics Unit, IRCCS San Raffaele Hospital Vita-Salute San Raffaele University Milan Italy.
DEN Open. 2024 Oct 4;5(1):e70021. doi: 10.1002/deo2.70021. eCollection 2025 Apr.
Although gastric peroral endoscopic myotomy (G-POEM) has shown substantial efficacy in patients with medically refractory gastroparesis (GP), comprehensive long-term data on its effectiveness are lacking.
We conducted a systematic review and meta-analysis including observational studies assessing long-term efficacy after G-POEM in patients with refractory GP. Our primary outcome was the pooled rate of clinical success 1-year after G-POEM. Secondary outcomes included clinical success at 2 and 3 years and the rate of adverse events according to the American Society for Gastrointestinal Endoscopy classification.
Thirteen studies, involving 952 patients with refractory GP undergoing G-POEM, were eligible. The pooled 1 year-clinical success was 0.72 (95% confidence interval [CI]: 0.56, 0.85, I = 94.9%). The clinical success was 0.67 (95% CI: 0.47, 0.97, I = 95.8%) when considering only studies defining success as 1 point decrease in Gastroparesis Cardinal Symptoms Index score and at least 25% decrease in two subscales. For patients who had 1-year success, the pooled clinical success at 2 and 3 years were 0.71 (95% CI: 0.45, 0.92, I = 94.9%) and 0.58 (95% CI: 0.19, 0.92, I = 97.1%), respectively. The pooled rate of adverse events was 0.08 (95% CI: 0.06, 0.10, I = 0%).
G-POEM is associated with successful outcomes in about 70% of treated cases after 1 year, with durable long-term effects lasting up to 3 years. In the future, new uniform outcome definitions and strict patient selection criteria are warranted to delineate G-POEM outcomes more accurately.
尽管经口内镜下胃肌切开术（G-POEM）已在难治性胃轻瘫（GP）患者中显示出显著疗效，但缺乏关于其有效性的全面长期数据。
我们进行了一项系统评价和荟萃分析，纳入了评估G-POEM治疗难治性GP患者长期疗效的观察性研究。我们的主要结局是G-POEM术后1年的综合临床成功率。次要结局包括2年和3年的临床成功率以及根据美国胃肠内镜学会分类的不良事件发生率。
13项研究符合条件，涉及952例接受G-POEM治疗的难治性GP患者。1年综合临床成功率为0.72（95%置信区间[CI]：0.56，0.85，I² = 94.9%）。仅考虑将成功定义为胃轻瘫主要症状指数评分降低1分且两个子量表至少降低25%的研究时，临床成功率为0.67（95%CI：0.47，0.97，I² = 95.8%）。对于1年成功的患者，2年和3年的综合临床成功率分别为0.71（95%CI：0.45，0.92，I² = 94.9%）和0.58（95%CI：0.19，0.92，I² = 97.1%）。不良事件综合发生率为0.08（95%CI：0.06，0.10，I² = 0%）。
G-POEM在约70%的治疗病例中1年后可获得成功结局，长期效果持久，可持续3年。未来，需要新的统一结局定义和严格的患者选择标准，以更准确地描述G-POEM的结局。
