Role of balloon dilation test in identifying suitable candidates for gastric peroral endoscopic myotomy.

Background: Predicting successful outcomes of gastric peroral endoscopic myotomy (G-POEM) is essential for identifying patients who are most likely to benefit from the procedure. This study aimed to evaluate the utility of the balloon dilation test (BDT) in optimizing patient selection for G-POEM.

Methods: A retrospective study was conducted from February 2021 to December 2023, including patients with refractory gastroparesis unresponsive to conventional medical treatments. All patients completed the Gastroparesis Cardinal Symptom Index (GCSI) questionnaire before and after G-POEM. The pyloric ring balloon dilation test was performed prior to G-POEM, with only patients who showed a positive response included. Procedural and clinical outcomes were analyzed.

Results: Five patients (three female and two male) with refractory gastroparesis were included. The median G-POEM procedure time was 60 minutes (interquartile range [IQR] 32.5-110), and technical success was achieved in all cases. At a median follow-up of 10 months (IQR 6-34), clinical response was observed in all patients (100%). The GCSI score improved significantly from a median of 17 (IQR 8-33) to 0 (IQR 0-4.5;  < 0.03) indicating significant improvement in clinical symptoms.

Conclusion: A positive response to the balloon dilation test appears to be a reliable predictor of successful short-term outcomes following G-POEM in patients with refractory gastroparesis.