TY - JOUR
T1 - Predictors of outcomes after gastric peroral endoscopic myotomy for refractory gastroparesis
T2 - a Systematic Review
AU - Varghese, Chris
AU - Lim, Alexandria
AU - Daker, Charlotte
AU - Sebaratnam, Gabrielle
AU - Gharibans, Armen A.
AU - Andrews, Christopher N.
AU - Hasler, William L.
AU - O’Grady, Greg
AU - Sujka, Joseph
AU - Ho, Vincent
AU - Cederwall, Chris
AU - Foong, Daphne
AU - Munwanwella, Niroshan
AU - Ragunath, Krish
AU - Schauer, Cameron
AU - Sekra, Anurag
AU - Dyavadi, Vijay
AU - Ogra, Ravinder
AU - Jue, Terry
AU - Mathur, Prateek
AU - Bulat, Robert
AU - Pawa, Rishi
AU - Buenz, Eric
AU - Poonawala, Nooriyah
AU - Calder, Stefan
PY - 2024/11/14
Y1 - 2024/11/14
N2 - INTRODUCTION: Gastroparesis is a debilitating gastroduodenal disorder for which gastric peroral endoscopic myotomy (GPOEM) has emerged as an efficacious treatment option. However, response to GPOEM varies between 50% and 80%, such that preoperative predictors of treatment success are needed to guide patient selection. METHODS: We performed a systematic review to identify predictors of clinical and functional response to GPOEM among adult patients with gastroparesis (PROSPERO: CRD42023457359). MEDLINE, Embase, and CENTRAL databases were searched systematically for studies reporting outcomes after GPOEM in September 2023. A narrative synthesis of predictive factors on univariable and multivariable analysis was performed with consideration of response rates through meta-analysis and evaluation of discrimination if prognostic models were developed. Risk Of Bias In Non-randomized Studies - of Exposures (ROBINS-E) was used for risk of bias assessment. RESULTS: Of 1899 articles reviewed, 30 were included. The GPOEM response rate was 63.1% (95% confidence interval 56.3%–69.5%) with most studies defining clinical success on the basis of improvement in gastroparesis cardinal symptom index (87%, 26/30). Older age, shorter duration of gastroparesis, nondiabetic etiology, lower body mass index, and response to intrapyloric botulinum toxin were associated with positive response to GPOEM on multivariable analyses. Predictors on physiological tests such as EndoFLIP or gastric emptying scintigraphy were inconsistent. No prognostic models underwent external validation. DISCUSSION: Currently, there are limited reproducible predictors of response to GPOEM among patients with refractory gastroparesis. Robust prospective studies investigating scalable, reproducible, and actionable biomarkers of treatment response are required.
AB - INTRODUCTION: Gastroparesis is a debilitating gastroduodenal disorder for which gastric peroral endoscopic myotomy (GPOEM) has emerged as an efficacious treatment option. However, response to GPOEM varies between 50% and 80%, such that preoperative predictors of treatment success are needed to guide patient selection. METHODS: We performed a systematic review to identify predictors of clinical and functional response to GPOEM among adult patients with gastroparesis (PROSPERO: CRD42023457359). MEDLINE, Embase, and CENTRAL databases were searched systematically for studies reporting outcomes after GPOEM in September 2023. A narrative synthesis of predictive factors on univariable and multivariable analysis was performed with consideration of response rates through meta-analysis and evaluation of discrimination if prognostic models were developed. Risk Of Bias In Non-randomized Studies - of Exposures (ROBINS-E) was used for risk of bias assessment. RESULTS: Of 1899 articles reviewed, 30 were included. The GPOEM response rate was 63.1% (95% confidence interval 56.3%–69.5%) with most studies defining clinical success on the basis of improvement in gastroparesis cardinal symptom index (87%, 26/30). Older age, shorter duration of gastroparesis, nondiabetic etiology, lower body mass index, and response to intrapyloric botulinum toxin were associated with positive response to GPOEM on multivariable analyses. Predictors on physiological tests such as EndoFLIP or gastric emptying scintigraphy were inconsistent. No prognostic models underwent external validation. DISCUSSION: Currently, there are limited reproducible predictors of response to GPOEM among patients with refractory gastroparesis. Robust prospective studies investigating scalable, reproducible, and actionable biomarkers of treatment response are required.
KW - endoscopy
KW - gastroparesis
KW - GPOEM
KW - predictors
UR - http://www.scopus.com/inward/record.url?scp=85214568957&partnerID=8YFLogxK
U2 - 10.14309/ajg.0000000000003213
DO - 10.14309/ajg.0000000000003213
M3 - Review article
C2 - 39733275
AN - SCOPUS:85214568957
SN - 0002-9270
JO - American Journal of Gastroenterology
JF - American Journal of Gastroenterology
ER -