Clinical Study Gastric Peroral Endoscopic Myotomy (G-POEM) as a Treatment for Refractory Gastroparesis: Long-Term Outcomes Jiaxin Xu, 1 Tianyin Chen, 1 Shaimaa Elkholy , 2 Meidong Xu, 1 Yunshi Zhong, 1 Yiqun Zhang, 1 Weifeng Chen, 1 Wenzheng Qin, 1 Mingyan Cai , 1 and Pinghong Zhou 1 1 Endoscopy Centre and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China 2 Internal Medicine Department, Gastroenterology Division, Faculty of Medicine, Cairo University, Egypt Correspondence should be addressed to Mingyan Cai; cai.mingyan@zs-hospital.sh.cn and Pinghong Zhou; zhou.pinghong@zs-hospital.sh.cn Received 24 May 2018; Revised 26 August 2018; Accepted 27 September 2018; Published 22 October 2018 Academic Editor: Maikel P. Peppelenbosch Copyright © 2018 Jiaxin Xu et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background and Aims. Gastric peroral endoscopic myotomy (G-POEM) has been regarded as a novel and minimally invasive therapy for refractory gastroparesis. Tis study reports the long-term outcomes and possible predictive factors for successful outcomes afer G-POEM in an Asian population. Methods. Tis is a retrospective single-centre study of 16 patients who underwent G-POEM for refractory gastroparesis from August 2016 to October 2017. Tis study included 11 males and 5 females; in addition, 13 patients had postsurgical gastroparesis, and 3 patients had diabetes. Te patients included had severe and refractory gastroparesis, as indicated by a Gastroparesis Cardinal Symptom Index (GCSI) score ≥20, and evidence of a delay on gastric emptying scintigraphy (GES). Te primary outcome parameter was an assessment of the long-term clinical efcacy of the procedure. Te secondary outcome parameter was the detection of possible predictive factors for success and the determination of cut-of values for such predictors. Results. Technical success was achieved in 100% of the patients, with a mean procedure time of 45.25±12.96 min. Te long-term clinical response was assessed in all patients during a median follow-up of 14.5 months. Clinical success was achieved in 13 (81.25%) patients. Tere was a signifcant reduction in the GCSI scores and GES values afer the procedure compared to the baseline values, with P values of <0.0001 and 0.012, respectively. Univariate regression analysis showed that the GCSI and GES had signifcant associations with the future clinical outcomes of the patients, but this fnding was not confrmed in multivariate analysis. A GCSI cut-of score of ≤30 had a high sensitivity and a negative predictive value (NPV) of 100% for predicting a successful procedure. GES (half emptying time ≤221.6 min and 2-hour retention ≤78.6%) had a high specifcity and a positive predictive value (PPV) of 100%. Conclusions. G-POEM is a safe and efective treatment option with a long-term efcacy of 81.6%. GCSI and GES could serve as good predictive measures. 1. Introduction Gastroparesis is a chronic and debilitating gastric motility disorder with limited efective therapeutic options [1]. Tis disorder can result in frequent hospitalization and repeated nutrition support interventions. Multiple conditions have been associated with gastroparesis, and most aetiologies are postsurgical, diabetic, or idiopathic [2]. Te pathogen- esis of delayed gastric emptying is associated with fundus abnormalities, antrum and antroduodenal discoordination, pyloric dysfunction, and abnormal small bowel motility [3]. Te pathogenesis of gastroparesis comprises two main components: altered gastric motility and increased pyloric pressure. Currently available medical therapies have limited efcacy and the potential for signifcant adverse events [4]. A recent innovation of the endoscopic submucosal tun- nelling technique is gastric peroral endoscopic myotomy (G- POEM). Tis technique is emerging as a promising option for the treatment of refractory gastroparesis. In 2013, Khashab et al. [5] reported the frst human case in a 27-year-old woman who was diagnosed with insulin-dependent diabetes mellitus at age 17 and was evaluated in the clinic for diabetic gastroparesis. Twelve weeks afer the procedure, she remained well with signifcant improvement in daily symptoms and was Hindawi Canadian Journal of Gastroenterology and Hepatology Volume 2018, Article ID 6409698, 10 pages https://doi.org/10.1155/2018/6409698