A comparison of technical and clinical success between lesser and greater curvature approaches in gastric peroral endoscopic myotomy: an updated systematic review and meta-analysis

Abstract

Background and Aims Gastric peroral endoscopic myotomy (G-POEM) is an endoscopic therapy for refractory gastroparesis (GP). We performed a systematic review and meta-analysis to assess G-POEM outcomes based on lesser curvature (LC) versus greater curvature (GC) approach. Methods Databases were queried from January 2000 to November 2023 for studies on G-POEM. Primary outcome was overall technical success (TS) rate stratified by approach. Secondary outcomes included clinical success (CS) rate, Gastroparesis Cardinal Symptom Index (GCSI) score, gastric emptying study retention, procedure time, myotomy length, length of stay (LOS), and adverse events (AEs). Pooled rates or means with 95% CI were calculated using a random effect model. Statistical analysis was done using Fisher exact test for categorical variables and t test for continuous variables. Results Among 621 patients across 16 studies (12 GC with 460 patients, 4 LC with 161 patients), the overall TS rate was 98.5% (95% CI, 96.8%-99.3%) and CS rate at 12 months was 64.2% (95% CI, 55.0%-72.5%). There were significant differences between GC and LC approaches in GCSI at 3 to 6 months and was 1.20 (SD 3.64) and 2.38 (SD 1.45); mild AEs were 9.6% and 1.2% (P = .0002); LOS was 2.14 days (95% CI, 1.54-2.74 days) and 1.46 days (95% CI, 1.12-1.79 days), respectively. Conclusions G-POEM is associated with high rates of technical and clinical success, both of which did not differ based on GC and LC approaches. The GCSI scores at 3 to 6 months were lower in the GC group, but mild AEs and LOS were higher. Further randomized trials are needed to determine whether outcomes differ by the approach.