A Systematic Review: Role of Pyloric Dilation in the Management of Gastroparesis
Milli Gupta, Alberto Barchi, Albert J. Bredenoord, Gwen M. C. MascleeABSTRACT
Background
Gastroparesis (GP) is a motility disorder characterized by pronounced delayed gastric emptying and associated with symptoms. Endoscopic pyloric dilation (PyD) is a minimally invasive option targeting pyloric dysfunction, though efficacy remains variably reported.
Aims
This systematic review assessed clinical outcomes and safety of PyD in adults and children with GP not associated with surgical manipulation.
Methods
PubMed, Embase, and Scopus were searched through December 2025 for studies evaluating PyD in GP. Post‐surgical and non‐GP etiologies were excluded. Twelve studies (12 full manuscripts) met inclusion criteria. Data on technique, response rates, and adverse events were extracted.
Results
Quality of studies was fair to poor. Symptom improvement with PyD was described in 37%–85% of treated patients. PyD plus botulin toxin efficacy was reported as 50%–80%. Benefits were reported as early as 2 weeks and up to 2 years after intervention. Repeat dilations were occasionally performed with response ranging from 40% to 95% for adults and children. No serious complications were reported. Adverse events were limited to transient pain reported in one study. Variability in technique and outcome definitions limited pooled analyses.
Conclusions
Within study quality constraints, PyD may be a low‐risk option for symptom relief in select GP patients across all age groups. As there was significant heterogeneity in the data published, well‐designed control studies should be performed to evaluate if this efficacy is convincing. Standardized protocols and integration of novel tools such as EndoFLIP are needed to refine patient selection and assess long‐term efficacy.