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Shim SH, Cheng J, Yu Haitong, et al. . J Am Coll Surg. October 2025.

This multicenter, propensity-matched trial provides valuable comparative data on two procedural approaches for medically refractory gastroparesis: endoscopic peroral pyloromyotomy (POP/G-POEM) and laparoscopic gastric electrical stimulation (GES).聽

The study included 226 matched patients (113 per group) and found that POP significantly reduced operative time (28.9 min. versus 95.6 min., p < 0.001), estimated blood loss (2.75 mL vs. 10.9 mL, p < 0.001), and hospital stay (0.5 days vs. 2.4 days, p < 0.001) compared to GES. Both procedures had similar immediate complication rates and short-term safety profiles, making POP a less invasive and lower-morbidity option for this complex patient group.

From an outcomes standpoint, surgeons can appreciate that POP yielded stronger functional and symptomatic improvement. The Gastroparesis Cardinal Symptom Index (GCSI) decreased by 37.2% (from 3.5 to 2.2; p < 0.001), crossing below the symptomatic threshold of 2.6. Gastric emptying improved comparably between the groups鈥攆rom 39.9% to 21.7% retention after GES and 39.7% to 20.5% after POP鈥攂ut recurrence of symptoms was markedly lower following POP (41.6% vs. 78.8%, p < 0.001).

Despite similar 1-year reintervention rates (9.7% vs. 14.2%), Kaplan鈥揗eier analysis showed that GES patients required more long-term corrective procedures, often due to device malfunction or symptom relapse.

Surgeons considering procedural sequencing can interpret this as evidence supporting a 鈥淧OP-first鈥� approach, reserving GES for select or secondary cases. The shorter operative duration, lower morbidity, and fewer recurrences make POP especially attractive for multidisciplinary teams focused on optimizing recovery and minimizing hospital resource use. The study鈥檚 large, matched sample and multicenter design strengthen its implications for contemporary surgical decision-making in gastroparesis management.