Endoscopic pylorotomy (G-POEM) is a recent technique that has already proven its effectiveness in the management of gastroparesis refractory to medical treatment. However, the procedure differs from one center to another, particularly with regard to whether a single, double or myectomy myotomy is performed. Furthermore, to date, no study has compared the different techniques in terms of efficacy and, above all, recurrence. The aim of this multicenter study is to compare these different methods in order to standardize the procedure in favor of the most effective one.

This is a retrospective multicenter study conducted in two expert centers in France, including patients treated with G-POEM for refractory gastroparesis between September 2015 and April 2025, with a comparison of three techniques: simple myotomy (SM), double myotomy (DM), or loop myectomy (LM).

The main objective was to evaluate clinical success according to the techniques used, defined by a one-point decrease in the Gastroparesis Cardinal Symptom Index (GCSI) score.

The primary objective was to evaluate clinical success according to the techniques used, defined by a decrease in the GCSI (Gastroparesis Cardinal Symptom Index) score of one point associated with a 50% decrease in one of the three subscores at 6 months.

The secondary objectives included clinical success at 12 and 24 months, improvement in the severity stage of gastroparesis assessed by scintigraphy, and the rate of recurrence of gastroparesis.

Secondary objectives included clinical success at 12 and 24 months,

improvement in the severity of gastroparesis as assessed by gastric emptying scintigraphy, the rate of symptomatic recurrence, and adverse events in each group.

A total of 122 patients were included, of whom 31 (25.4%) were treated with simple myotomy (SM), 73 (59.8%) with double myotomy (DM) and 18 (14.8%) with myectomy (MC).

The groups were comparable in terms of demographics, etiology and disease severity (preoperative GCSI). Clinical success at 6 months was not significantly different in the 3 groups, despite a trend in favor of myectomy: 46% for SM, 50% for DM and 77% for MC. However, the mean GCSI was significantly higher in the MS group (2.28 ± 1.14) compared to the other groups (1.79 ± 1.12 for MD and 1.46 ± 0.872; p<0.026).

Importantly, the recurrence rate (not evaluated in the MC group) was significantly higher in the MS group, where it was 71% compared to 12% in the MD group (p<0.005).

The improvement in gastric emptying, of at least 1 grade of scintigraphic severity, was similar in the 3 groups, ranging from 40 to 66%. Finally, the complication rate was not different in the 3 groups, ranging from 0.5 to 5%, mostly minor to moderate.

G-POEM remains an effective and safe technique for the management of refractory gastroparesis. No significant difference in clinical success was observed between the three myotomy approaches, but myectomy tends to offer better symptomatic results at 6 months. Double myotomy appears to significantly reduce the risk of recurrence compared to single myotomy, without increasing the complication rate.