Gastric electrical stimulation combined with pyloromyotomy or pyloroplasty in gastroparesis patients: a systematic review and meta-analysis

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Aims Gastroparesis (GP) is a chronic disorder characterized by delayed gastric emptying without mechanical obstruction. It significantly impacts the quality of life. Gastric electrical stimulation (GES) has been used as an important treatment option to improve symptoms in patients with GP who are refractory to medical therapy. According to recent research, the pyloroplasty procedure could improve the therapeutic benefits of GES. In patients with refractory GP, the combined use of GES with adjunct pyloroplasty (PS) or pyloromyotomy (PM) is the focus of this systematic review and meta-analysis. Methods We identified studies involving GP patients who underwent GES with adjunct pyloroplasty or pyloromyotomy. A literature search was done through PubMed, Web of Science, Scopus, Embase, and Cochrane databases from inception until September 2024. The primary outcomes included Gastroparesis Cardinal Symptom Index (GCSI), along with secondary outcomes, bloating, postprandial fullness, early satiety, and gastric retention at 4 hours. The data were analyzed using R version 4.4.1. Results Eleven observational studies were identified with a total of 687 patients enrolled. GES with adjunct pyloroplasty PS or PM at the GCSI score, bloating, postprandial fullness, early satiety, and gastric retention at 4 hours compared with PS or PM alone (MD=-0.84, 95% CI (-2 to 0.31) p=0.07, I2=0), (MD=0.23, 95% CI (-1.16 to 0.7), p=0.31, I2=0), (MD=0.09, 95% CI (-0.08 to 0.26), I2=0),(MD=-0.23, 95% CI (-0.42 to -0.04), I2=0) and (MD=-3.99, 95% CI (-10.53 to 2.55), I2=0) respectively. Conclusions : This systematic review and meta-analysis conclude that GES in combination with an adjunct has a potentially promising role in improving gastroparesis-related symptoms, particularly early satiety when compared to PS or PM alone. Further research, particularly randomized controlled trials, is required to confirm these preliminary results and assess the long-term benefits and safety of treating GES with PS or PM in patients with refractory gastroparesis. Publication History Article published online: 27 March 2025 © 2025. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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