When conservative treatments fail, the treatment of gastroparesis relies on endoscopic strategies, but the predictors of success for these treatments remain poorly identified. Gastric ptosis is an anatomo-clinical entity whose links with gastroparesis remain poorly understood. The main objective of our study was to investigate the influence of gastric ptosis on the response to pyloric endoscopic treatments in patients with clinical gastroparesis.

In this retrospective, single-centre study, all patients who underwent endoscopic treatment and TOGD between September 2012 and January 2025 were eligible. The primary objective was to evaluate the relationship between ptosis and treatment success (improvement in GCSI ≥ 1 after 3 months). Secondary objectives included identifying other factors predictive of treatment efficacy.

Forty-four patients with a median age of 52 years (36.9-61.4) were included. Gastric ptosis was significantly associated with a lower success rate of endoscopic treatment (5.56% vs. 48%, p = 0.003). Among the other criteria analysed, longer symptom duration and the presence of oesophageal motor disorder were significant predictors of failure (p=0.025 and p=0.001, respectively), while diabetic aetiology was associated with a higher success rate (p=0.019).

Our study is the first to identify gastric ptosis as a predictive factor for failure of pyloric treatments for gastroparesis. The inclusion of an upper gastrointestinal endoscopy in the pre-treatment assessment could be particularly relevant before proposing endoscopic pyloric treatment.