Patient-Reported Quality of Life Assessment and Utilization of Health Care After Gastric Peroral Endoscopic Pyloromyotomy (GPOEM): 2017 Fellows-in-Training Award (Interventional Endoscopy Category)

Abstract

Introduction: Current therapy for gastroparesis is limited, often times ineffective and results in frequent emergency room visits and hospitalizations. Gastric per oral endoscopic pyloromyotomy (GPOEM) is a promising treatment option for refractory gastroparesis. Due to its novelty, the existing data on long-term clinical outcomes and its impact on healthcare are lacking. This study aims to systematically assess the efficacy and safety of GPOEM using patient-reported metrics and utilization of health care.Figure: Improvement of GCSI after GPOEM GCSI: Gastroparesis cardinal symptom index.Figure: Improvement of GCSI after GPOEM GCSI: Gastroparesis Cardinal Symptom Index.Figure: Improvement of quality of life after GPOEM PF: physical functioning; RP: role limitation due to physical health; BP: bodily pain; GH: general health; VT: vitality; SF: social functioning; RE: role limitation due to emotional problems; MH: mental health.Methods: We performed a retrospective cohort study on outcomes of GPOEM on patients with refractory gastroparesis. Patient-reported gastroparesis cardinal symptoms index (GCSI), quality of life metrics assessed by standardized short-form 36 (SF36), and utilization of health care were collected at 0, 1, 6, 12, and 18-month after the procedure. Results: 30 patients with refractory gastroparesis who underwent GPOEM were included. GPOEM was technically successful in all patients. Mean gastroparesis cardinal symptom index (GCSI) decreased from 3.6+/-0.6 at baseline to 1.74+/-1.0 at 1-month (p < 0.00001), 1.7+/-1.1 at 6-month (p < 0.00001), 1.8+/-1.4 at 12-month (p=0.002), and 1.4+/-1.3 at 18-month (p=0.016) post-GPOEM with nausea and early satiety being the symptoms with highest response rate (p=0.0046 and 0.03). Significant improvements in quality of life in several domains were observed with 77.8%, 76.5%, 70%, and 83.3% of patients improved at 1, 6, 12, and 18-month after the procedure, respectively. 55.5% and 52.9% of patients had significantly improved pain at 1 and 6-month follow up (p=0.001 and 0.01), while only 40% and 33.3% reported better pain control at 12 and 18-month but with a nonsignificantly improved pain score (p=0.13 and 0.86). There was a significant decrease in the emergency room visit rate for gastroparesis-related symptoms from 2.2+/-3.1 to 0.3+/-0.8 times/month (p=0.003), while hospitalization rate significantly decreased from 1.7+/-2 to 0.2+/-0.4 times/month (p=0.0002). Only one patient (3.3%) had a complication with a tension capnoperitoneum requiring needle decompression. Conclusion: GPOEM results not only in clinical improvement that sustained throughout an 18-month period, but also significantly decreased utilization of healthcare resources and an improvement in overall quality of life. It is a therapeutic option for patients with refractory gastroparesis who have nausea/vomiting or early satiety as predominating symptoms, but less for bloating and pain.