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Surgical Endoscopy

, Volume 32, Issue 8, pp 3421–3431 | Cite as

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

  • Lianyong Li
  • Robert Spandorfer
  • Changmin Qu
  • Yongtao Yang
  • Shuwen Liang
  • Huimin Chen
  • Hanbing Xue
  • Qiang Cai
Review
  • 171 Downloads

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.

Keywords

Gastroparesis G-POEM Per-oral pyloromyotomy 

Notes

Author 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.

Compliance with ethical standards

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.

References

  1. 1.
    McCallum RW, George SJ (2001) Gastric dysmotility and gastroparesis. Curr Treat Options Gastroenterol 4:179–191CrossRefPubMedGoogle Scholar
  2. 2.
    Parkman HP, Hasler WL, Fisher RS, American Gastroenterological A (2004) American Gastroenterological Association technical review on the diagnosis and treatment of gastroparesis. Gastroenterology 127:1592–1622CrossRefPubMedGoogle Scholar
  3. 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 61:2344–2350CrossRefPubMedGoogle Scholar
  4. 4.
    Sangnes DA, Softeland E, Biermann M, Gilja OH, Thordarson H, Dimcevski G (2016) Gastroparesis - causes, diagnosis and treatment. Tidsskr Nor Laegeforen 136:822–826CrossRefPubMedGoogle Scholar
  5. 5.
    Park MI, Camilleri M (2006) Gastroparesis: clinical update. Am J Gastroenterol 101:1129–1139CrossRefPubMedGoogle Scholar
  6. 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 43:2398–2404CrossRefPubMedGoogle Scholar
  7. 7.
    Hasler WL (2011) Gastroparesis: pathogenesis, diagnosis and management. Nat Rev Gastroenterol Hepatol 8:438–453CrossRefPubMedGoogle Scholar
  8. 8.
    Jones MP, Maganti K (2003) A systematic review of surgical therapy for gastroparesis. Am J Gastroenterol 98:2122–2129CrossRefPubMedGoogle Scholar
  9. 9.
    Ahuja NK, Clarke JO (2017) Pyloric therapies for gastroparesis. Curr Treat Options Gastroenterol 15:230–240CrossRefPubMedGoogle Scholar
  10. 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 78:764–768CrossRefPubMedGoogle Scholar
  11. 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 86:282–289CrossRefPubMedGoogle Scholar
  12. 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 31:4617–4624CrossRefGoogle Scholar
  13. 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 Google Scholar
  14. 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 PubMedGoogle Scholar
  15. 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 28:1272–1277CrossRefPubMedGoogle Scholar
  16. 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 23:1843–1850CrossRefPubMedPubMedCentralGoogle Scholar
  17. 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 68:205–216CrossRefGoogle Scholar
  18. 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 29:2377–2384CrossRefPubMedGoogle Scholar
  19. 19.
    McCarty TR, Rustagi T (2015) Endoscopic treatment of gastroparesis. World J Gastroenterol 21:6842–6849CrossRefPubMedPubMedCentralGoogle Scholar
  20. 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 36:44–54CrossRefPubMedGoogle Scholar
  21. 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 95:1456–1462CrossRefPubMedGoogle Scholar
  22. 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 85:132–139CrossRefPubMedGoogle Scholar
  23. 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 85:123–128CrossRefPubMedGoogle Scholar
  24. 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 13:833–844CrossRefPubMedGoogle Scholar
  25. 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 93:92–98CrossRefPubMedGoogle Scholar
  26. 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 15:233–238CrossRefPubMedGoogle Scholar
  27. 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::e92-94Google Scholar
  28. 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::E796-799Google Scholar
  29. 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 29:543–551CrossRefPubMedGoogle Scholar
  30. 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 202:56–61CrossRefPubMedGoogle Scholar
  31. 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 9:63–67CrossRefPubMedPubMedCentralGoogle Scholar
  32. 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 Google Scholar
  33. 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–E136Google Scholar
  34. 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 46:364–370CrossRefPubMedGoogle Scholar
  35. 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:AB169CrossRefGoogle Scholar
  36. 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 80:164CrossRefPubMedGoogle Scholar
  37. 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 84:734–735CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Digestive DiseasesPLA 306 HospitalBeijingChina
  2. 2.Division of Digestive DiseasesEmory UniversityAtlantaUSA
  3. 3.Department of Gastroenterology, Renji HospitalJiaotong University School of MedicineShanghaiChina

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