A recent study depicted that gastric per-oral endoscopic myotomy (GPOEM) is a minimally invasive therapy with long-term safety and effectiveness in managing post-surgical gastroparesis. A prospective single-center study was carried out to investigate the long-term safety and efficacy of GPOEM in managing 79 postsurgical gastroparesis.

The symptomatic improvement based on gastroparesis cardinal symptoms index (GCSI) and the improvement of gastric emptying was the primary outcome parameter. Using three-dimensional ultrasound, the volume of the gastric antrum and the morphological structure of the pylorus tube were witnessed.

To assess the function of gastric emptying, estimation of half-emptying time, whole-emptying time was done by analyzing the volume change of gastric antrum. Utilizing the upper gastrointestinal imaging, the emptying of ioversol was witnessed.

The improvement of gastroesophageal reflux symptoms and complications of GPOEM were the secondary outcome parameters. To assess the improvement of gastroesophageal reflux symptoms, the  gastroesophageal reflux disease questionnaire (GERDQ) was utilized.

The severity of postsurgical gastroparesis was not linked with the onset time and the course of the disease. Throughout the follow-up period, the GPOEM substantially decreased. For different anastomotic sites, a considerable improvement of GCSI was witnessed at 6-month post-GPOEM (F4, 165= 74.18).

Subscale analysis of GCSI illustrated that nausea/vomiting, post-prandial fullness/early satiety, and bloating were considerably improved at 6-month post-GPOEM. In patients with the different anastomotic site after GPOEM, the half-emptying time and whole-emptying time were remarkably declined. 

Gastric emptying imaging demonstrated that after G-POEM, the emptying of iodofol was obviously accelerated. GCSI was not found to be linked with the diameter and length of pyloric and thickness of the pyloric wall. To evaluate the clinical efficacy of GPOEM, GERDQ was also utilized.

For each time point, GERDQ didn't differ substantially in patients with the different anastomotic site (F4,118=0.7391). For patients with the different anastomotic site, GERDQ was improved significantly at different time points (F4,118=63.47).

The higher the esophageal anastomotic site was, the faster GPOEM improved the symptoms of gastroesophageal reflux. Re-hospitalization for any complication was not needed by any participant.

Thus, the minimally invasive G-POEM therapy demonstrates long-term safety and effectiveness in managing patients having post-surgical gastroparesis. In the future, manometric measurements would be an interesting topic in determining the physiologic mechanism of GPOEM.