Clinical efficacy of gastric per-oral endoscopic myotomy (G-POEM) in the treatment of refractory gastroparesis and predictors of outcomes: a systematic review and meta-analysis using surgical pyloroplasty as a comparator group

Mohan, Babu P.; Chandan, Saurabh; Jha, Lokesh K.; Khan, Shahab R.; Kotagiri, Rajesh; Kassab, Lena L.; Ravikumar, Naveen Pg.; Bhogal, Neil; Chandan, Ojasvini Choudhry; Bhat, Ishfaq; Hewlett, Alexander; Jacques, Jérémie; Ponnada, Suresh; Asokkumar, Ravishankar; Adler, Douglas G.

doi:10.1007/s00464-019-07135-9

Cited by 70 publications

(72 citation statements)

References 36 publications

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“…In a large meta-analysis of 332 gastroparesis patients from 11 studies, one predictor of response to G-POEM was prior improvement after pyloric botulinum toxin therapy. 9 It also was typical of our referring physicians to limit the number of botulinum toxin treatments to minimize the risk of scar formation which theoretically could interfere with creating a submucosal tunnel prior to myotomy. 38 Scar tissue can develop after lower esophageal sphincter botulinum toxin injection in in achalasia, but has not been confirmed in the pylorus of gastroparesis patients.…”

Section: Regression Modeling To Define Predictors Of Improved Pylormentioning

confidence: 99%

“…[2][3][4][5][6] Gastric per-oral endoscopic myotomy (G-POEM) has been described in recent case series and systemic reviews for gastroparesis therapy. [7][8][9][10] Impedance planimetry measured by the Functional Lumen Imaging Probe (EndoFLIP) can quantify several pyloric motor parameters. EndoFLIP abnormalities in gastroparesis include reduced pyloric distensibility and diameter and increased pressure.…”

Section: Introductionmentioning

confidence: 99%

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Impact of gastric per‐oral endoscopic myotomy on static and dynamic pyloric function in gastroparesis patients

Watts

Baker

Lee

et al. 2020

Neurogastroenterology Motil

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Background: Functional Lumen Imaging Probe (EndoFLIP) tests typically measure static pyloric parameters, but the pylorus exhibits phasic variations on manometry. Dynamic changes in pyloric function have not been quantified using EndoFLIP, and the impact of Gastric Per-Oral Endoscopic Myotomy (G-POEM) on static and dynamic pyloric activity in gastroparesis is unknown. Methods: EndoFLIP balloon inflation to 30, 40, and 50 mL was performed to measure mean, maximum, and minimum values and variability in pyloric diameter and distensibility before and after G-POEM in 20 patients with refractory gastroparesis. The impact of phasic contractions on these pyloric measures was compared. Key Results: G-POEM increased mean (P < .0001) and maximum (P = .0002) pyloric diameters and mean (P = .02) and maximum (P = .02) pyloric distensibility on 50 mL EndoFLIP inflation but not intraballoon pressures or minimum diameters or distensibility. Temporal variability of pyloric diameter (P = .02) and distensibility (P = .02) also increased after G-POEM. Phasic coupled contractions propagating from the antrum through the pylorus were observed in 37.5% of recordings; other phasic activity including isolated pyloric contractions were seen in 23.3%. Variability of pyloric diameter and distensibility tended to be higher during recordings with phasic activity. Some pyloric responses to G-POEM were influenced by age, gastroparesis etiology, gastric emptying, and prior botulinum toxin injection. Conclusions & Inferences: Pyloric activity exhibits dynamic changes on EndoFLIP testing in gastroparesis. G-POEM increases maximal but not minimal diameter and distensibility with increased variations, suggesting this therapy enhances pyloric opening but may not impair pyloric closure. Phasic pyloric contractions contribute to variations in pyloric activity.

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Section: Regression Modeling To Define Predictors Of Improved Pylormentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of gastric per‐oral endoscopic myotomy on static and dynamic pyloric function in gastroparesis patients

Watts

Baker

Lee

et al. 2020

Neurogastroenterology Motil

View full text Add to dashboard Cite

show abstract

“…A recent systematic review and meta-analysis comparing G-POEM with surgical pyloloroplasty has shown equal efficacy (based on gastroparesis cardinal symptom index [GCSI] 75.8 vs. 77.3% and based on 4-hour gastric emptying scintigraphy [GES] 85.1 vs. 84%) and safety (adverse events 11.4 vs. 11%). 32 The adverse events in the G-POEM group in decreasing order of frequency were bleeding (0.04%), abdominal pain (0.03%), capnoperitoneum (0.02%), perforation (0.01%), ulcer (0.01%), pyloric stricture (two cases), dehydration (two cases), and abscess (one case). The advantages of G-POEM were less operative time and incisionless surgery.…”

Section: Gastric Per Oral Endoscopic Myotomy (G-poem) For Refractory mentioning

confidence: 96%

“…The advantages of G-POEM were less operative time and incisionless surgery. 32 As more, robust data emerges G-POEM might become the treatment of choice in refractory gastroparesis and in a certain subset of patients, it might be the upfront treatment.…”

Section: Gastric Per Oral Endoscopic Myotomy (G-poem) For Refractory mentioning

confidence: 99%

“An Odyssey of Third Space Endoscopy”—from Entry into the Tunnel to Entry into the Peritoneal Cavity

Mandavdhare

Mishra

Samanta

et al. 2019

Journal of Digestive Endoscopy

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The last decade has seen the growth of a completely new and exciting entity called the third space endoscopy (TSE) that has brought about a paradigm shift in the way we manage various disorders of the gastrointestinal tract. The journey started with per oral endoscopic myotomy (POEM) for achalasia cardia and within a decade the concept has been exploited to its best potential for disorders including submucosal tumor resection, pyloromyotomy for gastroparesis, complete division of septum without the risk of perforation in diverticular diseases of esophagus, restoration of esophageal lumen in long strictures, restoration of bowel movement in Hirschsprung's disease, and then taking the concept to the next level of pure NOTES (natural orifice transluminal endoscopic surgery) by entering the peritoneal cavity and performing fundoplication. This review will discuss the history of TSE with brief discussion about the various applications and what has been achieved till present. AbstractKeywords ► third space ► per oral endoscopic myotomyfundoplication ► robotic ► endoscopy

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“…Moreover, as the function of esophageal conduits changes over time after surgery, different results may be obtained depending on the evaluation period [ 4 , 6 , 26 ]. Finally, endoscopic techniques (EBD, BT, and even PM) [ 14 - 16 , 30 , 33 , 34 ] can be used for DGE or GOO, with different outcomes. As such, there is difficulty in controlling for these numerous variables to identify the optimal pyloric procedure.…”

Section: Comparative Studies and Expert Reviewsmentioning

confidence: 99%

The Optimal Pyloric Procedure: A Collective Review

Kim

2020

Korean J Thorac Cardiovasc Surg

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Vagal damage and subsequent pyloric denervation inevitably occur during esophagectomy, potentially leading to delayed gastric emptying (DGE). The choice of an optimal pyloric procedure to overcome DGE is important, as such procedures can lead to prolonged surgery, shortening of the conduit, disruption of the blood supply, and gastric dumping/bile reflux. This study investigated various pyloric methods and analyzed comparative studies in order to determine the optimal pyloric procedure. Surgical procedures for the pylorus include pyloromyotomy, pyloroplasty, or digital fracture. Botulinum toxin injection, endoscopic balloon dilatation, and erythromycin are non-surgical procedures. The scope, technique, and effects of these procedures are changing due to advances in minimally invasive surgery and postoperative interventions. Some comparative studies have shown that pyloric procedures are helpful for DGE, while others have argued that it is difficult to reach an objective conclusion because of the variety of definitions of DGE and evaluation methods. In conclusion, recent advances in interventional technology and minimally invasive surgery have led to questions regarding the practice of pyloric procedures. However, many clinicians still perform them and they are at least somewhat effective. To provide guidance on the optimal pyloric procedure, DGE should first be defined clearly, and a large-scale study with an objective evaluation method will then be required.

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Clinical efficacy of gastric per-oral endoscopic myotomy (G-POEM) in the treatment of refractory gastroparesis and predictors of outcomes: a systematic review and meta-analysis using surgical pyloroplasty as a comparator group

Cited by 70 publications

References 36 publications

Impact of gastric per‐oral endoscopic myotomy on static and dynamic pyloric function in gastroparesis patients

Impact of gastric per‐oral endoscopic myotomy on static and dynamic pyloric function in gastroparesis patients

“An Odyssey of Third Space Endoscopy”—from Entry into the Tunnel to Entry into the Peritoneal Cavity

The Optimal Pyloric Procedure: A Collective Review

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