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Gastric Per Oral Endoscopic Myotomy (G-POEM) for the Treatment of Refractory Gastroparesis: Early Experience

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Abstract

Background

Gastric per oral endoscopic myotomy (G-POEM) of the pylorus is a technique that is recently being used to treat gastroparesis. Our aim was to report our experience in performing G-POEM for refractory gastroparesis of different etiologies and determine symptom improvement.

Methods

Thirteen patients undergoing G-POEM are reported. Pre- and post-procedure gastric emptying study (GES) and PAGI-SYM for symptom severity were obtained. Patients underwent G-POEM by creating a submucosal tunnel starting in the greater curvature of the distal antrum and extending it to the beginning of the duodenal bulb, followed by a full thickness pyloromyotomy.

Results

All 13 gastroparesis patients successfully underwent G-POEM (one diabetic [DGp], four idiopathic [IGp], eight postsurgical [PSGp]). Postsurgical patients included 4 s/p esophagectomy for esophageal cancer, 3 s/p Nissen fundoplication, and 1 s/p esophagectomy for achalasia. There were no procedure-related side effects. Of 11 patients completing follow-up questionnaires, eight were improved subjectively (four patients reported considerably better, four patients somewhat better, one unchanged, and two worse). Individual symptom severity scores tended to improve, particularly vomiting, retching, and loss of appetite. Of six patients that had post-G-POEM GES; GES improved in four, unchanged in one, and worsened in one).

Conclusions

G-POEM for treatment of refractory gastroparesis appears to be a feasible and safe technique that can be successfully performed in patients with a variety of etiologies including different types of postsurgical gastroparesis. Our initial experience suggests that the majority of patients report some improvement in symptoms, particularly symptoms of vomiting, retching, and loss of appetite. Further experience is needed to determine the efficacy and safety of G-POEM and predict those who best respond to this treatment.

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Authors and Affiliations

  1. Gastroenterology Section, Department of Medicine, Temple University School of Medicine, 3401 N Broad Street, Parkinson Pavilion 8th floor, Philadelphia, PA, 19140, USA

    Zubair Malik, Rahul Kataria, Adam C. Ehrlich, Ron Schey, Henry P. Parkman & Stavros N. Stavropoulos

  2. Division of Gastroenterology, Hepatology, and Nutrition, Winthrop University Hospital, Mineola, NY, USA

    Rani Modayil & Stavros N. Stavropoulos

Authors
  1. Zubair Malik
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  2. Rahul Kataria
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  3. Rani Modayil
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  4. Adam C. Ehrlich
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  5. Ron Schey
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  6. Henry P. Parkman
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  7. Stavros N. Stavropoulos
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Contributions

Zubair Malik, MD was involved in study concept and design; data entry; analysis and interpretation of data; statistical analysis; drafting of manuscript. Rahul Kataria, MD, Adam C. Ehrlich, MD, Ron Schey, MD contributed to analysis and interpretation of data; critical revision of the manuscript for important intellectual content. Rani Modayil, MD helped in analysis and interpretation of data; statistical analysis; critical revision of the manuscript for important intellectual content. Henry P. Parkman, MD, Stavros Stavropoulos, MD were involved in study concept and design; analysis and interpretation of data; critical revision of the manuscript for important intellectual content; study supervision.

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Correspondence to Henry P. Parkman.

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Malik, Z., Kataria, R., Modayil, R. et al. Gastric Per Oral Endoscopic Myotomy (G-POEM) for the Treatment of Refractory Gastroparesis: Early Experience. Dig Dis Sci 63, 2405–2412 (2018). https://doi.org/10.1007/s10620-018-4976-9

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  • DOI: https://doi.org/10.1007/s10620-018-4976-9

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