Outcomes after per oral pyloromyotomy based on gastroparesis etiology

Background: Per oral pyloromyotomy (POP) has been shown to be effective in patients with gastroparesis. The three most common etiologies of gastroparesis are diabetic, postsurgical, and idiopathic. Our aim was to compare outcomes after POP based on the etiology of gastroparesis.

Methods: This was a retrospective cohort study of all patients that underwent POP between 2018 and 2023 at a single tertiary academic center. Patient factors such as demographics, previous interventions, and preoperative symptoms were compared between patients of diabetic, post-surgical, and idiopathic gastroparesis. Primary outcomes of interest included postoperative symptoms, recurrence, time to recurrence, and reinterventions.

Results: A total of 46 patients were included in the study of which 12 had diabetic, 23 had post-surgical, and 11 had idiopathic. The overall median age was 56.5 with a female predominance (61%). Twenty patients (43%) had previous endoscopic intervention, 2 (4%) had prior surgical intervention, and 15 (33%) were on medications at the time of referral. Patients had a median of 2 symptoms preoperatively, the most common being nausea (83%) and emesis (76%). There was no difference in demographic and preoperative factors between patients with different etiologies. There was an overall decrease in the number of symptoms for all patients (p < 0.001). There was no difference in postoperative symptoms between cohorts. Fourteen (33%) patients had recurrence of symptoms over a median of 6.5 months with 5 (11%) patients having another endoscopic intervention and 3 (7%) patients having surgical intervention. There were no differences in outcomes between the groups.

Conclusions: In our limited cohort, there were no differences in preoperative factors or postoperative outcomes for patients undergoing POP for different etiologies of gastroparesis. There was no differences in recurrence rate or in duration until recurrence. Patients with different etiologies of gastroparesis benefit similarly from POP.