S0951 Effect of Opiate Usage on Patient Outcomes After Gastric Per-Oral Endoscopic Pyloromyotomy (GPOEM) for Refractory Gastroparesis

Abstract

INTRODUCTION: Chronic opioid use is prevalent in patients with gastroparesis and has been associated with more severe gastrointestinal symptoms and increased healthcare utilization. GPOEM has gained recognition as an effective endoscopic therapy for treatment of refractory gastroparesis. Currently there is limited knowledge of the effect of opiate use in patients undergoing GPOEM. METHODS: We performed a single-center retrospective study of patients who underwent GPOEM for refractory gastroparesis. Patients were stratified into two groups: 1) patients on chronic opiates prior to or after GPOEM and 2) patients who were not on chronic opiates prior to or after GPOEM. Primary outcomes included gastric emptying study results pre- and post-GPOEM and symptom response pre- and post-GPOEM as measured by the Gastroparesis Cardinal Symptom Index (GCSI), a validated nine-item questionnaire with 3 subscores that rate symptom severity from absent (0) to severe (5). Univariate statistical analysis was performed using t-test (SAS, version 9.4). RESULTS: 22 patients underwent GPOEM from 2017 to 2019. Nine (41%) patients were prescribed chronic opiates both prior to and after GPOEM, while 13 (59%) patients did not have chronic opiate prescriptions before and after GPOEM. The etiology of gastroparesis was predominantly post-surgical, accounting for 7 (78%) patients on opiates and 8 (62%) of patients without opiates. Mean follow-up time for all patients after GPOEM was 8.21 ± 4.6 months. Opiate users had higher baseline and post-GPOEM four-hour residuals on GES compared to patients without opiate use (baseline: 59.3% vs 43%, P = 0.18; post-GPOEM: 40.3% vs 19.7%, P = 0.27). Mean total GCSI prior to GPOEM was not significantly different between opiate and non-opiate users (3.24 vs 3.01, P = 0.63). Non-opiate users had significantly lower mean total GCSI after GPOEM compared to patients on opiates (1.32 vs 2.32, P < 0.05), as well as significantly greater overall improvement in GCSI. (56% vs 17%, P < 0.05). CONCLUSION: Non-opiate users appear to respond more favorably to GPOEM as characterized by significantly greater improvements in GCSI scores, and significantly lower overall GCSI scores following this intervention. Multidisciplinary approaches incorporating opioid weaning protocols prior to GPOEM may improve symptom-based outcomes subsequent to this procedure.Table 1.: Clinical Characteristics of Patients with and without Opiate Use before and after GPOEMFigure 1