Supplementary Material for: Gastric peroral endoscopic myotomy for refractory gastroparesis with a median follow up of 10 months-An Indian experience

Background- Gastric peroral endoscopic myotomy has shown promising results for refractory gastroparesis. We share our Indian experience of gastric peroral endoscopic myotomy performed over the last 5 years. Methods- This is a retrospective study of prospectively maintained data of patients who underwent gastric peroral endoscopic myotomy for refractory gastroparesis at our centre. The primary outcome was to assess the clinical success at 3 months measured by ≥ 50% reduction of gastroparesis cardinal symptom index score from the baseline. The secondary outcomes were to assess the technical success, change in percentage retention at 4 hours in gastric emptying scintigraphy at 6 months, change in gastroparesis cardinal symptom index score, Patient Assessment of Upper Gastrointestinal Disorders-Quality of Life score at 1, 6 months and 1 year respectively and adverse event rate graded by AGREE classification. Results- Between 2019 and 2024 16 patients underwent gastric peroral endoscopic myotomy in our unit. The median (IQR) age was 40 (30.5,48.75), and 10 were females (62.5%). The most common etiology was idiopathic (11/16, 68.8%). The clinical success at 3 months was 72.4% (8/11) which was sustained at 6 months and 1 year of follow-up to 71.7% (5/7). The technical success was 100%. There was a significant reduction in gastroparesis cardinal symptom index score, Patient Assessment of Upper Gastrointestinal Disorders-Quality of Life score at 1, 3, 6 months and 1 year. Similarly, there was a significant reduction in the percentage retention at 4 hours in gastric emptying scintigraphy at 6 months. One patient needed intraoperative needle aspiration of the capnoperitoneum while another had hematemesis after discharge which was managed conservatively. Conclusion- Our first Indian experience of gastric peroral endoscopic myotomy for refractory gastroparesis shows similar outcomes compared to global literature with gastric peroral endoscopic myotomy emerging as a preferred modality in these subsets of patients.