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.
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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).
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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). https://doi.org/10.1007/s11605-017-3510-2
- Per-oral pyloromyotomy
- G-POEM (gastric-per oral endoscopic myotomy)
- Intramural surgery
- Surgical endoscopy