From the Guidelines
In patients with refractory gastroparesis, the use of gastric per-oral endoscopic myotomy (G-POEM) compared to medical management may improve symptoms and reduce gastric emptying times, but its long-term efficacy and safety are unknown. A potential PICO question for a gastroenterology topic without a systematic review could be: "In patients with refractory gastroparesis (P), does the use of G-POEM (I) compared to medical management (C) improve symptoms and reduce gastric emptying times (O)?" This topic examines G-POEM, a novel endoscopic technique, as a potential treatment for refractory gastroparesis, a condition characterized by delayed gastric emptying and debilitating symptoms 1. While G-POEM has shown promise in preliminary studies, its specific effects on refractory gastroparesis patients haven't been systematically reviewed. The intervention would typically involve a single G-POEM procedure, with primary outcomes measuring changes in symptom scores and gastric emptying times.
- Key considerations for this question include:
- The technical feasibility of G-POEM and its potential to improve symptoms and reduce gastric emptying times
- The lack of randomized, sham-controlled studies and long-term follow-up data
- The potential risks and adverse events associated with G-POEM, including dumping syndrome
- The need for a team approach of experts, including motility specialists and advanced endoscopists, to perform G-POEM
- The current evidence suggests that G-POEM may be a useful treatment option for refractory gastroparesis, but further studies are needed to fully evaluate its efficacy and safety 1. G-POEM should only be considered for patients with refractory gastroparesis who have failed medical management and should be performed at tertiary care centers with extensive experience in treating refractory gastroparesis patients.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
PICO Question
- P: Patients with gastroparesis
- I: Investigating the effectiveness of gastric electrical stimulation
- C: Compared to traditional medical therapy
- O: Outcome of interest is reduction in symptoms of nausea and vomiting
Rationale
The PICO question is focused on patients with gastroparesis, a common cause of chronic nausea and vomiting 2. The intervention of interest is gastric electrical stimulation, which has been proposed as a therapeutic option for patients with intractable symptomatic gastroparesis 3. The comparison is to traditional medical therapy, which includes prokinetic and antiemetic agents 4. The outcome of interest is the reduction in symptoms of nausea and vomiting, which is a key goal of treatment for patients with gastroparesis 5.
Relevant Studies
- A study published in 2002 found that gastric electrical stimulation had an immediate and potent anti-emetic effect in patients with intractable symptomatic gastroparesis 3.
- A study published in 2013 found that permanent gastric electrical stimulation improved symptoms of nausea and vomiting in children with functional dyspepsia and gastroparesis who failed medical therapy 6.
- A review published in 2025 noted that there is still a considerable unmet need for efficacious medications specifically for the treatment of gastroparesis, especially in refractory cases 5.
Gaps in Current Research
There is a need for further research on the effectiveness of gastric electrical stimulation compared to traditional medical therapy for patients with gastroparesis, particularly in terms of long-term outcomes and potential side effects 3, 6. Additionally, there is a need for more research on the pharmacologic management of gastroparesis, including the development of new prokinetic and antiemetic agents 5.