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Assessment of the length of myotomy in peroral endoscopic pyloromyotomy (G-POEM) using a submucosal tunnel technique (video)

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Abstract

Background

Peroral endoscopic pyloromyotomy is a novel technique that has recently been described in the literature. There is little data to guide the length of myotomy created. The aim of study was to evaluate the proper incision length of the muscular layer during peroral endoscopic pyloromyotomy using a submucosal tunnel technique.

Methods

The study was designed as a prospective ex vivo study. Fresh ex vivo porcine stomachs from animals weighing 80–100 kg and porcine stomachs from animals weighing 15–25 kg were used for pyloromyotomy. Four different myotomy lengths (1, 2, 3, and 4) were compared in the large animal series and three different myotomy lengths (1, 2, and 3) were compared in the small series. A total of 23 cases of the submucosal tunnel technique were performed by two endoscopists using 12 large stomachs and 11 small stomachs.

Results

The mean overall procedure time (±SD) of pyloromyotomy was 65.7 (±14.3) min. In the large stomach series, the mean pyloric diameter (±SD) and change from baseline (as percentage) following a 1, 2, 3, and 4 pyloromyotomy were 13.3 ± 9.5 mm (7.1 %), 20.7 ± 11.7 mm (10.6 %), 31.1 ± 15.0 mm (15.2 %), and 33.0 ± 15.0 mm (16.0 %), respectively. In the small stomach series, the changes of mean pyloric diameter following a 1, 2, and 3 cm pyloromyotomy were 12.2 ± 5.6 mm (7.5 %), 23.1 ± 7.6 mm (13.1 %), and 28.0 ± 10.4 mm (15.5 %), respectively.

Conclusions

A 3 cm pyloromyotomy for a large animal series and 2 cm for the small animal series appeared to be most appropriate for enlargement of the pylorus.

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Disclosures

Kai Matthes: Olympus America Inc. (consultation and material support), Ovesco Endoscopy USA Inc. (consultation and material support), Endosim LLC (ownership). Mark Gromski: Endosim LLC (consultant). Ram Chuttani: Consultant—Olympus America. Yunho Jung, Jongchan Lee, Masayuki Kato, Sam Rodriguez have identified a conflict of interest.

Funding

Olympus America Inc. (Center Valley, PA), Endosim, LLC (Berlin, MA), Medical Measurement Systems (Cronspon, Galway, NH) provided material support.

Author information

Authors and Affiliations

  1. Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Yunho Jung, Jongchan Lee, Mark A. Gromski, Masayuki Kato, Ram Chuttani & Kai Matthes

  2. Division of Gastroenterology, Department of Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea

    Yunho Jung

  3. Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan

    Masayuki Kato

  4. Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA

    Sam Rodriguez & Kai Matthes

Authors
  1. Yunho Jung
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  2. Jongchan Lee
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  3. Mark A. Gromski
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  4. Masayuki Kato
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  5. Sam Rodriguez
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  6. Ram Chuttani
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  7. Kai Matthes
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Corresponding author

Correspondence to Yunho Jung.

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IRB/IACUC

The study required no IRB or IACUC review since no human subjects or live animals were used in the study. Ex vivo porcine specimens were utilized from a commercial distributor.

Electronic supplementary material

Video 1: Endoscopic video demonstrating the endoscopic pyloromyotomy procedure as performed in this study.

Supplementary material 1 (WMV 13,708 kb)

Supplementary material 2 (WMV 13,919 kb)

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Jung, Y., Lee, J., Gromski, M.A. et al. Assessment of the length of myotomy in peroral endoscopic pyloromyotomy (G-POEM) using a submucosal tunnel technique (video). Surg Endosc 29, 2377–2384 (2015). https://doi.org/10.1007/s00464-014-3948-1

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  • DOI: https://doi.org/10.1007/s00464-014-3948-1

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