Endoscopic ultrasound–guided gastroenterostomy for managing gastroparesis refractory to gastric peroral endoscopic pylorotomy: a promising new therapeutic option

TL;DR

Endoscopic ultrasound-guided gastroenterostomy shows promise for treating gastroparesis that doesn't respond to other endoscopic treatments.

Contribution

This study is the first to evaluate EUS-GEA as a treatment for refractory gastroparesis following G-POEM failure.

Findings

EUS-GEA achieved a 75% clinical efficacy rate at 6 months in patients with refractory gastroparesis.

Symptoms significantly improved, with no severe periprocedural adverse events observed.

Median follow-up was 11.5 months, with half of patients never improving from baseline before EUS-GEA.

Abstract

Gastric peroral endoscopic myotomy (G-POEM) reaches an efficacy rate around 65% for gastroparesis. Endoscopic ultrasound (EUS)–guided gastroenteroanastomosis (EUS-GEA) has demonstrated efficacy in gastric outlet obstruction. We evaluated it for refractory gastroparesis.

We undertook a single-center retrospective study enrolling patients with gastroparesis treated with G-POEM with failure or symptoms recurrence managed with EUS-GEA. The drain-assisted EUS-GEA technique with 20-mm lumen-apposing stent was applied. End points were clinical efficacy at 6 months, adverse events, and recurrence rate.

Twelve patients were included, median age 46 years (interquartile range [IQR], 16-78 y). Patients had an abnormal gastric emptying or bezoar, and 50% never improved from baseline. Median follow-up was 11.5 months (IQR, 6-26 mo). Clinical efficacy rate was 75% at 6 months. The median preoperative Gastroparesis Cardinal Symptoms Index was 4.1 (IQR, 1.6-5) versus 1.6 (IQR, 0-2.6; P < .05). No severe periprocedural adverse events occurred.

EUS-GEA demonstrated promising results in improving patients with gastroparesis refractory to G-POEM. Prospective evaluation is required to confirm these results.

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