Factors Associated With Improvement of Symptom Index in Patients With Gastroparesis After Per-Oral Pyloromyotomy

Abstract

Introduction: Gastroparesis is a debilitating disease and per oral pyloromyotomy (POP) is a fairly new endoscopic technique that has been proposed as an alternative to surgical pyloroplasty. Candidate selection for POP or patient factors associated with improved outcomes with POP need further evaluation. Given that the goal of this procedure is to improve patient symptoms and functioning, we have evaluated pre-operative patient factors associated with a significant improvement of Gastroparesis Cardinal Symptom Index (GCSI). Methods: We evaluated patients with gastroparesis who have both pre- and post-POP GCSI scores in the Cleveland Clinic health system. Baseline characteristics were described. Improvement was defined as post-operative minus pre-operative GCSI score of ≥ 5. Univariable logistic regression was used to evaluate demographic and clinical factors associated with improvement. Results: N=45 patients met inclusion criteria (98% female; mean age 45 years). Results of univariable logistic regression of factors associated with improvement in GCSI were outlined in Table 1. For every 1 point increase in the pre-POP GCSI, the odds of improved outcome increases by 12% [Odds Ratio (OR), 1.12 (95%CI: 1.01, 1.24)]. Specifically GCSI sub-scores of “bloating” [OR, 2.67 (95%CI: 1.39, 5.11)], and “stomach or belly is visibly larger” [OR, 2.96 (95%CI: 1.46, 6.02)] were both associated with improved outcomes (increment of 1 point). Percentage of patients with improved outcomes based on overall and sub-scores of GCSI were graphically represented (Figures 1a, 1b).442_A Figure 1. Univariate analysis of factors associated with significant improvement of GCSI score. Improvement is defined as difference between post-operative and pre-operative GCSI score of ≥ 5.Conclusion: In our analysis, high pre-operative GCSI score was the only factors associated with improved symptom outcomes after POP. Therefore, in evaluating a patient for POP, use of other expensive testing modalities may not be necessary. However, larger studies are needed to validate this conclusion.442_B Figure 2. Percent with improvement (defined as difference between post-operative and pre-operative GCSI score of ≥ 5) after per oral endoscopic pyloromyotomy as a function of preoperative GCSI score.442_C Figure 3. Percent with improvement after per oral endoscopic pyloromyotomy as a function of preoperative GCSI sub-score “Bloating” and “Stomach or belly is visibly larger”.