Gastroenterology · Surgery · 2 h ago
SAGES consensus outlines surgical options for refractory gastroparesis
A SAGES systematic review and expert consensus considers surgical and endoscopic options for medically refractory gastroparesis. The panel regards gastric electrical stimulation, pyloroplasty and pyloromyotomy—including G-POEM—as reasonable options, but bases its statements on expert opinion because the underlying evidence is poor and heterogeneous.
- Consensus addresses four procedural approaches to refractory gastroparesis.
- GES, pyloroplasty and pyloromyotomy were considered reasonable options.
- Gastrectomy was not suggested as a standard treatment.
- Statements rely on expert opinion amid weak, heterogeneous evidence.
The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) reviewed literature published through December 31, 2024, on surgical treatment of medically refractory gastroparesis. The review covered gastric electrical stimulation (GES), gastric per-oral endoscopic myotomy (G-POEM), pyloroplasty and pyloromyotomy, and gastrectomy. It considered symptom resolution and changes in gastric emptying; findings were discussed by a panel of surgeons and gastroenterologists, with patient-partner perspectives considered.
The panel judged GES, pyloroplasty and pyloromyotomy, including G-POEM, to be reasonable treatments for medically refractory disease. It did not recommend surgical resection as a standard option, while acknowledging that resection may be reasonable in selected cases.
The consensus statements are based on expert opinion rather than strong comparative evidence: the review found poor and heterogeneous datasets for each intervention. The authors identify evidence gaps and call for further research. The guidance may help frame discussions of procedural options, but it does not establish the superiority of one approach or support a standard role for gastrectomy.
In practice
For patients with medically refractory gastroparesis being considered for procedural treatment, the SAGES panel considers GES, pyloroplasty and pyloromyotomy, including G-POEM, reasonable options. It does not support gastrectomy as a standard treatment, although it may be considered in selected cases. These are consensus views based on expert opinion, not robust comparative evidence: the underlying studies were poor and heterogeneous. The guidance does not establish which procedure is preferable or justify a uniform procedural approach.
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Surgical Endoscopy: SAGES surgical management of gastroparesis: systematic review and expert consensus ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.