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REDO RATES AND OUTCOMES OF GASTRIC PERORAL ENDOSCOPIC MYOTOMY (G-POEM) VS PYLOROPLASTY: A RETROSPECTIVE ANALYSIS
Chamanthi Konidala, Cameron Dabbs, Ryan Shargo, Isaac Poonen-Honig, Bailey Blankenship, Salvatore Docimo, Christopher DuCoin, Rebecca Klam, Camille Thélin, Joseph Sujka
*GI Surgery, University of South Florida, Tampa, FL
Background: Gastroparesis is a chronic gastrointestinal motility disorder characterized by delayed gastric emptying without mechanical obstruction. For medically refractory cases, surgical interventions including gastric peroral endoscopic myotomy (G-POEM) and pyloroplasty have emerged as effective treatment modalities. Despite their growing utilization, data comparing the rates and clinical outcomes of redo procedures between these techniques remain limited.
Objective: This study aims to compare the frequency, nature, and clinical outcomes of redo procedures following G-POEM and pyloroplasty in patients with refractory gastroparesis.
Methods: A retrospective review was conducted on patients with refractory gastroparesis undergoing either G-POEM or pyloroplasty from 2019 to 2024. Data collected included redo procedure rates, time to reintervention, and post-intervention outcomes. Statistical analyses were performed using Pearson’s chi-square or Fisher’s exact tests for categorical variables and the Mann-Whitney U test for continuous variables.
Results: Among 173 patients included in the analysis, 85 (49.1%) underwent G-POEM and 88 (50.9%) underwent pyloroplasty as primary procedures. Patients undergoing pyloroplasty were significantly more likely to present with pre-operative reflux (p = 0.048) and have a concurrent procedure (p < 0.001). Forty-two patients (24%) underwent a redo procedure for persistent symptoms including 22 (52.4%) patients with prior G-POEM and 20 (47.6%) with prior pyloroplasty. Mean time from initial procedure to redo was 383.18 days (SD = 302.26), which did not differ between initial intervention types (p = 0.156).
Whereas rates of reintervention did not differ between groups (p = 0.628), patients with prior G-POEM were significantly more likely to undergo a secondary pyloroplasty while patients with prior pyloroplasty more often underwent placement of a gastric neurostimulator (p = 0.008). Symptom [JS1] [RS2] [RS3] improvement following a redo procedure was similar between the groups (p = 0.326), with 50% of patients reporting improvement and 19% achieving complete symptom resolution.
Conclusion: G-POEM and pyloroplasty demonstrate comparable rates of redo procedures, with notable differences in the types of secondary interventions performed. These findings underscore the importance of patient-specific treatment planning during reintervention.
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