How I Do It: Per-Oral Pyloromyotomy (POP)

  • 571 Accesses

  • 9 Citations



Several surgical treatments exist for treatment of gastroparesis, including gastric electrical stimulation, pyloroplasty, and gastrectomy. Division of the pylorus by means of endoscopy, Per-Oral Pyloromyotomy (POP), is a newer, endoluminal therapy that may offer a less invasive, interventional treatment option.


We describe and present a video of our step by step technique for POP using a lesser curvature approach. The following are technical steps to complete the POP procedure from the lesser curve approach.


In our experience, these methods provide promising initial results with low operative risks, although long-term outcomes remain to be determined.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6


  1. 1.

    Bharucha AE. Epidemiology and natural history of gastroparesis. Gastroenterol Clin North Am [Internet]. 2015;44(1):9–19. Available from:

  2. 2.

    Choung RS, Locke GR, Schleck CD, Zinsmeister AR, Melton LJ, Talley NJ. Risk of Gastroparesis in Subjects With Type 1 and 2 Diabetes in the General Population. Am J Gastroenterol [Internet]. 2012; 107(1):82–8. Available from:

  3. 3.

    McCarty TR, Rustagi T. Endoscopic treatment of gastroparesis. World J Gastroenterol. 2015;21(22):6842–9.

  4. 4.

    Toro JP, Lytle NW, Patel AD, Davis SS, Christie JA, Waring JP, et al. Efficacy of laparoscopic pyloroplasty for the treatment of gastroparesis. J Am Coll Surg [Internet]. 2014;218(4):652–60. Available from:

  5. 5.

    Clarke JO, Snape WJ. Pyloric sphincter therapy: Botulinum toxin, stents, and pyloromyotomy. Gastroenterol Clin North Am [Internet] 2015;44(1):127–36. Available from:

  6. 6.

    Sarosiek I, Davis B, Eichler E, McCallum RW. Surgical approaches to treatment of gastroparesis: Gastric electrical stimulation, pyloroplasty, total gastrectomy and enteral feeding tubes. Gastroenterol Clin North Am [Internet]. 2015;44(1):151–67. Available from:

  7. 7.

    Khashab MA, Stein E, Clarke JO, Saxena P, Kumbhari V, Chander Roland B, et al. Gastric peroral endoscopic myotomy for refractory gastroparesis: First human endoscopic pyloromyotomy (with video). Gastrointest Endosc. 2013;78(5):764–8.

  8. 8.

    Ponsky JL, Marks JM, Pauli EM. How I Do It: Per-Oral Endoscopic Myotomy (POEM). J Gastrointest Surg. 2012;16(6):1251–5.

  9. 9.

    Gonzalez JM, Lestelle V, Benezech A, Cohen J, Vitton V, Grimaud JC, et al. 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 [Internet]. 2016;85(1):132–9. Available from:

  10. 10.

    Khashab MA, Ngamruengphong S, Carr-Locke D, Bapaye A, Benias PC, Serouya S, et al. Gastric per-oral endoscopic myotomy for refractory gastroparesis: results from the first multicenter study on endoscopic pyloromyotomy (with video). Gastrointest Endosc [Internet]. 2016;1–6. Available from:

  11. 11.

    Mekaroonkamol P, Li LY, Dacha S, Xu Y, Keilin SD, Willingham FF, et al. Gastric peroral endoscopic pyloromyotomy (G-POEM) as a salvage therapy for refractory gastroparesis: a case series of different subtypes. Neurogastroenterol Motil. 2016;28(8):1272–7.

  12. 12.

    Camilleri M, Parkman HP, Shafi M A, Abell TL, Gerson L. Clinical guideline: Management of gastroparesis. Am J Gastroenterol [Internet]. 2013;108(1):18–37. Available from:

  13. 13.

    Fukami N, Anderson MA, Khan K, Harrison ME, Appalaneni V, Ben-Menachem T, et al. The role of endoscopy in gastroduodenal obstruction and gastroparesis. Gastrointest Endosc. 2011;74(1):13–21.

  14. 14.

    Lo SK, Fujii-Lau LL, Enestvedt BK, Hwang JH, Konda V, Manfredi MA, et al. The use of carbon dioxide in gastrointestinal endoscopy. Gastrointest Endosc [Internet]. 2016;83(5):857–65. Available from:

  15. 15.

    Bratzler DW, Houck PM. Antimicrobial prophylaxis for surgery: An advisory statement from the National Surgical Infection Prevention Project. Am J Surg. 2005;189(4):395–404.

  16. 16.

    Revicki DA, Rentz AM, Dubois D, Kahrilas P, Stanghellini V, Talley NJ, et al. Gastroparesis Cardinal Symptom Index (GCSI): Development and validation of a patient reported assessment of severity of gastroparesis symptoms. Qual Life Res. 2004;13(4):833–44.

Download references

All POP procedures to date have been performed in the operating room. The patient is placed supine on the operating table. Intravenous access is secured, general anesthesia induced and the patient oro-tracheally intubated. If the patient has had a previous GES placed, the device is turned off using the interrogator. Surgical steps are placed on the floor along the patient’s left side to make an elevated platform, enabling a more comfortable working height for the surgical endoscopist. The procedure may be performed by one or two operators. In the two-operator system, one endoscopist holds the scope at the lips and controls insertion depth and torque. The other endoscopist operates the wheels and manipulates instruments in the working channel (Fig. 1).

Author information

All authors participated sufficiently on this work to be considered by the ICMJE guidelines for authorship.

Correspondence to Matthew T. Allemang.

Ethics declarations


None relevant by any of the authors.

Electronic Supplementary Material

(AVI 162221 kb)

(AVI 162221 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Allemang, M.T., Strong, A.T., Haskins, I.N. et al. How I Do It: Per-Oral Pyloromyotomy (POP). J Gastrointest Surg 21, 1963–1968 (2017).

Download citation


  • POP
  • Per-oral pyloromyotomy
  • G-POEM (gastric-per oral endoscopic myotomy)
  • Gastroparesis
  • Intramural surgery
  • Surgical endoscopy