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Gastric emptying study before gastric peroral endoscopic myotomy (G-POEM): can intragastric meal distribution be a predictor of success?
  1. Francesco Vito Mandarino1,
  2. Sabrina Gloria Giulia Testoni1,
  3. Alberto Barchi1,
  4. Gino Pepe2,
  5. Dario Esposito1,
  6. Lorella Fanti1,
  7. Edi Viale1,
  8. Paolo Biamonte1,
  9. Francesco Azzolini1,
  10. Silvio Danese1
  1. 1Gastroenterology and Endoscopy Unit, San Raffaele Hospital and Vita-Salute San Raffaele University, Milano, Italy
  2. 2Division of Nuclear Medicine, San Raffaele Hospital and Vita-Salute San Raffaele University, Milano, Italy
  1. Correspondence to Dr Francesco Vito Mandarino, Gastroenterology and Endoscopic Unit, San Raffaele Hospital and Vita-Salute San Raffaele University, Milano, Italy; mandarino.francesco{at}

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We read with great interest the article by Vosoughi et al,1 describing outcomes of gastric peroral endoscopic myotomy (G-POEM), performed on 80 patients with refractory gastroparesis. Clinical and Gastric Emptying Study (GES) improvement achieved in 56% and 64.2% of patients, respectively, are meaningful, even though the need to find predictors of G-POEM success and to select optimal patients remains a pivotal issue.2

Despite showing fairly better results, the largest studies in literature have not identified useful non-invasive parameters to foresee postprocedural success.3 4 Vosoughi et al found baseline Gastric Cardinal Symptom Index (GCSI) >2.6 and 4 hours per cent gastric retention (PGR) >20% as predictors of 12-month clinical response, defined as 1-score decrease in total GCSI with a decrease of 25% in at least two out of three symptomatic subscales.1

Concerning invasive parameters predicting success, contrasting results have been provided by high pylorus distensibility, evaluated with preprocedural Functional Lumen Imaging Probe (FLIP) (EndoFlip V.2.0 Medtronic). While in a retrospective study of 37 patients, FLIP measurement was correlated with clinical improvement after G-POEM,5 in a recent prospective report by Gregor et al the distensibility index has not proved to be …

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  • FVM and SGGT contributed equally.

  • Contributors Acquisition and interpretation of data: FVM, SGGT, AB, GP, DE, LF, EV, PB, FA and SD. Drafting of the manuscript: FVM, SGGT and AB. Critical revision of the manuscript: SD. Final approval: FVM, SGGT, AB, GP, DE, LF, EV, PB, FA, SD.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests SD has served as a speaker, consultant, and advisory board member for Schering-Plough, AbbVie, Actelion, Alphawasserman, AstraZeneca, Cellerix, Cosmo Pharmaceuticals, Ferring, Genentech, Grunenthal, Johnson and Johnson, Millenium Takeda, MSD, Nikkiso Europe GmbH, Novo Nordisk, Nycomed, Pfizer, Pharmacosmos, UCB Pharma and Vifor.

  • Provenance and peer review Not commissioned; internally peer reviewed.