G-POEM for Refractory Gastroparesis and role of EndoFLIP to Predict Clinical Success: GIE| July 2026

Introduction:

Gastric peroral endoscopic myotomy (G-POEM) has become an effective treatment for refractory gastroparesis. Endoscopic Functional Luminal Imaging Probe (EndoFLIP) allows real-time assessment of pyloric physiology, but its ability to predict clinical response remains uncertain. This systematic review and meta-analysis evaluated the relationship between pyloric impedance planimetry and outcomes after G-POEM.

Why was this study needed?

• G-POEM is increasingly used for refractory gastroparesis, but not all patients respond.
• Reliable biomarkers to predict treatment success are lacking.
• EndoFLIP provides objective measurements of pyloric function during G-POEM.
• The clinical value of cross-sectional area (CSA) and distensibility index (DI) has not been clearly established.
• Better patient selection could improve procedural outcomes.

Results:

• G-POEM achieved an overall clinical success rate exceeding 70%, confirming its effectiveness across different gastroparesis subtypes.
• Both pyloric cross-sectional area (CSA) and distensibility index (DI) increased significantly after G-POEM, demonstrating improved pyloric compliance following myotomy.
• Neither post-procedure CSA nor DI reliably differentiated clinical responders from non-responders. However, CSA showed a stronger association with symptom improvement than DI, suggesting it may be a more stable physiological marker.

Clinical Impact:

This meta-analysis confirms that EndoFLIP is valuable for documenting physiological changes during G-POEM, but its role as a standalone predictor of long-term clinical success remains limited. Cross-sectional area (CSA) appears more promising than distensibility index (DI) and deserves further prospective validation with standardized measurement protocols.

Bottom Line:

G-POEM provides meaningful symptom improvement in more than 70% of patients with refractory gastroparesis. While EndoFLIP confirms improved pyloric opening after myotomy, current impedance planimetry measurements alone cannot reliably predict clinical success, although CSA may emerge as the more useful biomarker.