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Gastric per-oral endoscopic myotomy for refractory gastroparesis: a detailed description of the procedure, our experience, and review of the literature

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Abstract

Background and Aims

Gastric per-oral endoscopic myotomy (G-POEM) was introduced four years ago as an investigational procedure for refractory gastroparesis. The safety and efficacy were currently evaluated. With our recent studies on G-POEM, we share our experience and knowledge through the discussion of a detailed description of the procedure and review of the literature. To our knowledge, this is the first systemic review on this new therapeutic endoscopic procedure.

Methods

The indications and contraindications, various aspects of the procedure, and efficacy assessment are discussed based on our experience and current available data.

Results

Preoperative preparation, detailed description of the procedure, post-procedural care, and results in the literature are presented. The procedure is safe and effective. 70–80% of patients have significant improvement in overall symptoms and quality of life in short-term (6 months) follow-up, as assessed by Gastric Cardinal Symptom Index and Short Form 36.

Conclusions

G-POEM is a feasible and effective procedure for refractory gastroparesis based on early and limited data. Well-designed prospective studies are expected to advance and evaluate this new procedure in the future.

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References

  1. McCallum RW, George SJ (2001) Gastric dysmotility and gastroparesis. Curr Treat Options Gastroenterol 4:179–191

    Article  PubMed  Google Scholar 

  2. Parkman HP, Hasler WL, Fisher RS, American Gastroenterological A (2004) American Gastroenterological Association technical review on the diagnosis and treatment of gastroparesis. Gastroenterology 127:1592–1622

    Article  PubMed  Google Scholar 

  3. Barkin JA, Czul F, Barkin JS, Klimas NG, Rey IR, Moshiree B (2016) Gastric enterovirus infection: a possible causative etiology of gastroparesis. Dig Dis Sci 61:2344–2350

    Article  PubMed  Google Scholar 

  4. Sangnes DA, Softeland E, Biermann M, Gilja OH, Thordarson H, Dimcevski G (2016) Gastroparesis - causes, diagnosis and treatment. Tidsskr Nor Laegeforen 136:822–826

    Article  PubMed  Google Scholar 

  5. Park MI, Camilleri M (2006) Gastroparesis: clinical update. Am J Gastroenterol 101:1129–1139

    Article  PubMed  Google Scholar 

  6. Soykan I, Sivri B, Sarosiek I, Kiernan B, McCallum RW (1998) Demography, clinical characteristics, psychological and abuse profiles, treatment, and long-term follow-up of patients with gastroparesis. Dig Dis Sci 43:2398–2404

    Article  PubMed  CAS  Google Scholar 

  7. Hasler WL (2011) Gastroparesis: pathogenesis, diagnosis and management. Nat Rev Gastroenterol Hepatol 8:438–453

    Article  PubMed  CAS  Google Scholar 

  8. Jones MP, Maganti K (2003) A systematic review of surgical therapy for gastroparesis. Am J Gastroenterol 98:2122–2129

    Article  PubMed  Google Scholar 

  9. Ahuja NK, Clarke JO (2017) Pyloric therapies for gastroparesis. Curr Treat Options Gastroenterol 15:230–240

    Article  PubMed  Google Scholar 

  10. Khashab MA, Stein E, Clarke JO, Saxena P, Kumbhari V, Chander Roland B, Kalloo AN, Stavropoulos S, Pasricha P, Inoue H (2013) Gastric peroral endoscopic myotomy for refractory gastroparesis: first human endoscopic pyloromyotomy (with video). Gastrointest Endosc 78:764–768

    Article  PubMed  Google Scholar 

  11. Dacha S, Mekaroonkamol P, Li L, Shahnavaz N, Sakaria S, Keilin S, Willingham F, Christie J, Cai Q (2017) Outcomes and quality-of-life assessment after gastric per-oral endoscopic pyloromyotomy (with video). Gastrointest Endosc 86:282–289

    Article  PubMed  Google Scholar 

  12. Xue HB, Fan HZ, Meng XM, Cristofaro S, Mekaroonkamol P, Dacha S, Li LY, Fu XL, Zhan SH, Cai Q (2017) Fluoroscopy-guided gastric peroral endoscopic pyloromyotomy (G-POEM): a more reliable and efficient method for treatment of refractory gastroparesis. Surg Endosc 31:4617–4624

    Article  Google Scholar 

  13. Koul A, Dacha S, Mekaroonkamol P, Li X, Li L, Shahnavaz N, Keilin S, Willingham FF, Christie J, Cai Q (2017) Fluoroscopic gastric peroral endoscopic pyloromyotomy (G-POEM) in patients with a failed gastric electrical stimulator. Gastroenterol Rep. https://doi.org/10.1093/gastro/gox040

    Article  Google Scholar 

  14. Mekaroonkamol P, Li L, Cai Q (2017) The role of pyloric manometry in gastric per-oral endoscopic pyloromyotomy (G-POEM): response to Jacques et al. Neurogastroenterol Motil. https://doi.org/10.1111/nmo.12949

    Article  PubMed  Google Scholar 

  15. Mekaroonkamol P, Li LY, Dacha S, Xu Y, Keilin SD, Willingham FF, Cai Q (2016) Gastric peroral endoscopic pyloromyotomy (G-POEM) as a salvage therapy for refractory gastroparesis: a case series of different subtypes. Neurogastroenterol Motil 28:1272–1277

    Article  PubMed  CAS  Google Scholar 

  16. Zhou JQ, Tang XW, Ren YT, Wei ZJ, Huang SL, Gao QP, Zhang XF, Yang JF, Gong W, Jiang B (2017) Endoscopic submucosal tunnel dissection of upper gastrointestinal submucosal tumors: a comparative study of hook knife vs hybrid knife. World J Gastroenterol 23:1843–1850

    Article  PubMed  PubMed Central  Google Scholar 

  17. Standards of Practice C, Lichtenstein DR, Jagannath S, Baron TH, Anderson MA, Banerjee S, Dominitz JA, Fanelli RD, Gan SI, Harrison ME, Ikenberry SO, Shen B, Stewart L, Khan K, Vargo JJ (2008) Sedation and anesthesia in GI endoscopy. Gastrointest Endosc 68:205–216

    Article  Google Scholar 

  18. Jung Y, Lee J, Gromski MA, Kato M, Rodriguez S, Chuttani R, Matthes K (2015) Assessment of the length of myotomy in peroral endoscopic pyloromyotomy (G-POEM) using a submucosal tunnel technique (video). Surg Endosc 29:2377–2384

    Article  PubMed  Google Scholar 

  19. McCarty TR, Rustagi T (2015) Endoscopic treatment of gastroparesis. World J Gastroenterol 21:6842–6849

    Article  PubMed  PubMed Central  Google Scholar 

  20. Abell TL, Camilleri M, Donohoe K, Hasler WL, Lin HC, Maurer AH, McCallum RW, Nowak T, Nusynowitz ML, Parkman HP, Shreve P, Szarka LA, Snape WJ Jr, Ziessman HA, American N, Motility S, the Society of Nuclear M (2008) Consensus recommendations for gastric emptying scintigraphy: a joint report of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine. J Nucl Med Technol 36:44–54

    Article  PubMed  Google Scholar 

  21. Tougas G, Eaker EY, Abell TL, Abrahamsson H, Boivin M, Chen J, Hocking MP, Quigley EM, Koch KL, Tokayer AZ, Stanghellini V, Chen Y, Huizinga JD, Ryden J, Bourgeois I, McCallum RW (2000) Assessment of gastric emptying using a low fat meal: establishment of international control values. Am J Gastroenterol 95:1456–1462

    Article  PubMed  CAS  Google Scholar 

  22. Gonzalez JM, Lestelle V, Benezech A, Cohen J, Vitton V, Grimaud JC, Barthet M (2017) Gastric per-oral endoscopic myotomy with antropyloromyotomy in the treatment of refractory gastroparesis: clinical experience with follow-up and scintigraphic evaluation (with video). Gastrointest Endosc 85:132–139

    Article  PubMed  Google Scholar 

  23. Khashab MA, Ngamruengphong S, Carr-Locke D, Bapaye A, Benias PC, Serouya S, Dorwat S, Chaves DM, Artifon E, de Moura EG, Kumbhari V, Chavez YH, Bukhari M, Hajiyeva G, Ismail A, Chen YI, Chung H (2017) Gastric per-oral endoscopic myotomy for refractory gastroparesis: results from the first multicenter study on endoscopic pyloromyotomy (with video). Gastrointest Endosc 85:123–128

    Article  PubMed  Google Scholar 

  24. Revicki DA, Rentz AM, Dubois D, Kahrilas P, Stanghellini V, Talley NJ, Tack J (2004) Gastroparesis Cardinal Symptom Index (GCSI): development and validation of a patient reported assessment of severity of gastroparesis symptoms. Qual Life Res 13:833–844

    Article  PubMed  Google Scholar 

  25. Choi MG, Camilleri M, Burton DD, Zinsmeister AR, Forstrom LA, Nair KS (1998) Reproducibility and simplification of 13C-octanoic acid breath test for gastric emptying of solids. Am J Gastroenterol 93:92–98

    Article  PubMed  CAS  Google Scholar 

  26. Rhie JK, Hayashi Y, Welage LS, Frens J, Wald RJ, Barnett JL, Amidon GE, Putcha L, Amidon GL (1998) Drug marker absorption in relation to pellet size, gastric motility and viscous meals in humans. Pharm Res 15:233–238

    Article  PubMed  CAS  Google Scholar 

  27. Chaves DM, Gusmon CC, Mestieri LH, de Moura EG, Veras MM, Pessorrusso FC, Sakai P (2014) A new technique for performing endoscopic pyloromyotomy by gastric submucosal tunnel dissection. Surg Laparosc Endosc Percutan Tech 24::e92-94

    Google Scholar 

  28. Geyl S, Legros R, Charissou A, Mesturoux L, Couquet CY, Carrier P, Brayette A, El-Ouafi Z, Loustaud-Ratti V, Sautereau D, Monteil J, Jacques J (2016) Peroral endoscopic pyloromyotomy accelerates gastric emptying in healthy pigs: proof of concept. Endosc Int Open 4::E796-799

    Google Scholar 

  29. Shlomovitz E, Pescarus R, Cassera MA, Sharata AM, Reavis KM, Dunst CM, Swanstrom LL (2015) Early human experience with per-oral endoscopic pyloromyotomy (POP). Surg Endosc 29:543–551

    Article  PubMed  Google Scholar 

  30. Wellington J, Scott B, Kundu S, Stuart P, Koch KL (2017) Effect of endoscopic pyloric therapies for patients with nausea and vomiting and functional obstructive gastroparesis. Auton Neurosci 202:56–61

    Article  PubMed  Google Scholar 

  31. Ohara Y, Toyonaga T, Tanabe A, Takihara H, Baba S, Inoue T, Ono W, Kawara F, Tanaka S, Azuma T (2016) Endoscopic antralplasty for severe gastric stasis after wide endoscopic submucosal dissection in the antrum. Clin J Gastroenterol 9:63–67

    Article  PubMed  PubMed Central  Google Scholar 

  32. Zheng WW, Zhang MM, Zhang Y, Li Z, Zuo XL, Lu XF, Li YQ (2017) Gastric per oral endoscopic myotomy (G-POEM) for pylorospasm: case report and literature review. J Dig Dis. https://doi.org/10.1111/1751-2980.12509

    Article  PubMed  Google Scholar 

  33. Gonzalez JM, Vanbiervliet G, Vitton V, Benezech A, Lestelle V, Grimaud JC, Barthet M (2015) First European human gastric peroral endoscopic myotomy, for treatment of refractory gastroparesis. Endoscopy 47(Suppl 1 UCTN):E135–E136

    Google Scholar 

  34. Gonzalez JM, Benezech A, Vitton V, Barthet M (2017) G-POEM with antro-pyloromyotomy for the treatment of refractory gastroparesis: mid-term follow-up and factors predicting outcome. Aliment Pharmacol Ther 46:364–370

    Article  PubMed  CAS  Google Scholar 

  35. Gonzalez JM, Benezech A, Vitton V, Barthet M (2016) Per oral endoscopic pyloromyotomy after sub-mucosal tunnel for the treatment of refractory gastroparesis: The First European Clinical Series. Gastrointest Endosc 83:AB169

    Article  Google Scholar 

  36. Chaves DM, de Moura EG, Mestieri LH, Artifon EL, Sakai P (2014) Endoscopic pyloromyotomy via a gastric submucosal tunnel dissection for the treatment of gastroparesis after surgical vagal lesion. Gastrointest Endosc 80:164

    Article  PubMed  Google Scholar 

  37. Bapaye A, Mahadik M, Pujari R, Vyas V, Dubale N (2016) Per-oral endoscopic pyloromyotomy and per-oral endoscopic myotomy for coexisting refractory gastroparesis and recurrent achalasia cardia in a single patient. Gastrointest Endosc 84:734–735

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Digestive Diseases, PLA 306 Hospital, Beijing, China

    Lianyong Li, Changmin Qu, Yongtao Yang & Shuwen Liang

  2. Division of Digestive Diseases, Emory University, 1365 Clifton Road, B1262, Atlanta, GA, 30322, USA

    Robert Spandorfer & Qiang Cai

  3. Department of Gastroenterology, Renji Hospital, Jiaotong University School of Medicine, Shanghai, China

    Huimin Chen & Hanbing Xue

Authors
  1. Lianyong Li
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  2. Robert Spandorfer
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  3. Changmin Qu
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  4. Yongtao Yang
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  7. Hanbing Xue
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  8. Qiang Cai
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Contributions

LL, wrote the first draft and revised of the manuscript; RS, CQ, YY, SL, HC, HX revised the manuscript; QC designed the study, performed the procedures, provided all the figures, and revised the manuscript.

Corresponding author

Correspondence to Qiang Cai.

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Disclosures

Drs Lianyong Li, Robert Spandorfer, Changmin Qu, Yongtao Yang, Shuwen Liang, Huimin Chen, Hanbing Xue, and Qiang Cai have no conflicts of interest or financial ties to disclose.

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Li, L., Spandorfer, R., Qu, C. et al. Gastric per-oral endoscopic myotomy for refractory gastroparesis: a detailed description of the procedure, our experience, and review of the literature. Surg Endosc 32, 3421–3431 (2018). https://doi.org/10.1007/s00464-018-6112-5

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