Utility of gastric peroral endoscopic myotomy for gastroparesis after lung transplant
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Background: Gastroparesis is common among lung transplant recipients and can exacerbate gastroesophageal reflux disease, thereby increasing the risk of microaspiration and graft failure. We aimed to evaluate the safety and efficacy of gastric peroral endoscopic myotomy (G-POEM) in this patient population. Methods: This retrospective study was conducted at two U.S.-based centers. Clinical success was defined as at least a one-point overall reduction in total Gastroparesis Cardinal Symptom Index (GCSI) score, along with a 25% reduction in at least two GCSI subscores. Results: Twenty-five patients were identified. Of the 24 patients with follow-up data, 15 (63%) achieved clinical success. The median overall GCSI decreased from 2.3 (interquartile range [IQR] 1.3–3.6) to 0.7 (IQR 0–1.8), P = 0.0002. Two patients (8%) developed intraprocedural bleeding, both of which were controlled with coagulation forceps. One patient suffered a duodenal disruption, which was managed with nasogastric suction. None experienced severe adverse events. Conclusion: G-POEM is feasible and safe in lung transplant recipients, and significantly improves symptoms in most patients.
Abstract
Background: Gastroparesis is common among lung transplant recipients and can exacerbate gastroesophageal reflux disease, thereby increasing the risk of microaspiration and graft failure. We aimed to evaluate the safety and efficacy of gastric peroral endoscopic myotomy (G-POEM) in this patient population. Methods: This retrospective study was conducted at two U.S.-based centers. Clinical success was defined as at least a one-point overall reduction in total Gastroparesis Cardinal Symptom Index (GCSI) score, along with a 25% reduction in at least two GCSI subscores. Results: Twenty-five patients were identified. Of the 24 patients with follow-up data, 15 (63%) achieved clinical success. The median overall GCSI decreased from 2.3 (interquartile range [IQR] 1.3–3.6) to 0.7 (IQR 0–1.8), P = 0.0002. Two patients (8%) developed intraprocedural bleeding, both of which were controlled with coagulation forceps. One patient suffered a duodenal disruption, which was managed with nasogastric suction. None experienced severe adverse events. Conclusion: G-POEM is feasible and safe in lung transplant recipients, and significantly improves symptoms in most patients.