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

Li, Lianyong; Spandorfer, Robert; Qu, Changmin; Yang, Yongtao; Liang, Shuwen; Chen, Huimin; Xue, Hanbing; Cai, Qiang

doi:10.1007/s00464-018-6112-5

Cited by 15 publications

(10 citation statements)

References 38 publications

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“…The safety profile of G-POEM in the current study was consistent with that of other studies [10,20], and includes established safety as a salvage operation in patients with failed GES treatment [11,15]. Device-related adverse events occurred in 13 % of patients who underwent GES treatment, which is similar to a GES system removal rate of 6.7 % -13 % reported in other studies [3,6].…”

Section: Discussionsupporting

confidence: 88%

“…G-POEM was performed as described in our previous reports [14,15]. Briefly, the procedure was performed using a gastroscope (GIF-H190; Olympus, Tokyo, Japan) with a transparent distal cap attachment (MH-588; Olympus) and Hybrid knife Itype (ERBE Elektromedizin GmbH, Tübingen, Germany) or a HookKnife (Olympus), and using only carbon dioxide for insufflation (UCR, Olympus).…”

Section: G-poemmentioning

confidence: 99%

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Gastric peroral endoscopic pyloromyotomy versus gastric electrical stimulation in the treatment of refractory gastroparesis: a propensity score-matched analysis of long term outcomes

et al. 2020

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Background Gastric peroral endoscopic pyloromyotomy (G-POEM) and gastric electrical stimulation (GES) have been reported as treatment options for refractory gastroparesis. In this study, we compared the long term clinical outcomes of G-POEM versus GES in the treatment of such patients. Methods We retrospectively evaluated 111 consecutive patients with refractory gastroparesis between January 2009 and August 2018. To overcome selection bias, we used propensity score matching (1:1) between G-POEM and GES treatment. The primary outcome was the duration of clinical response. Results After propensity score matching, 23 patients were included in each group. After a median follow-up of 27.7 months, G-POEM had a significantly better and longer clinical response than GES (hazard ratio [HR] for clinical recurrence 0.39, 95 % confidence interval [CI] 0.16 – 0.95; P = 0.04). The median duration of response was 25.4 months (95 %CI 8.7 – 42.0) in the GES group and was not reached in the G-POEM group. The Kaplan – Meier estimate of 24-month clinical response rate was 76.6 % with G-POEM vs. 53.7 % with GES. GES appeared to have little effect on idiopathic gastroparesis (HR for recurrence with G-POEM vs. GES 0.35, 95 %CI 0.13 – 0.95; P = 0.05). The incidence of adverse events was higher in the GES group (26.1 % vs. 4.3 %; P = 0.10). Conclusion Among patients with refractory gastroparesis, clinical response was better and lasted longer with G-POEM than with GES. The positive outcomes with G-POEM are likely to derive from the superior clinical response in patients with idiopathic gastroparesis. Further studies are needed to confirm these findings.

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Section: Discussionsupporting

confidence: 88%

Section: G-poemmentioning

confidence: 99%

Gastric peroral endoscopic pyloromyotomy versus gastric electrical stimulation in the treatment of refractory gastroparesis: a propensity score-matched analysis of long term outcomes

et al. 2020

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“…Gentamycin rinse was advocated by some centers[47]. Other technical variations among endoscopists include site of mucosal entry (lesser vs greater curve), mucosotomy closure tools (clips vs suture), depth of pyloromyotomy, and the need for fluoroscopy[2,45,50-52]. Though general anesthesia is recommended in all studies but conscious sedation in endoscopy suite can be safely and successfully performed as well[49].…”

Section: Procedural Techniquesmentioning

confidence: 99%

Outcomes of per oral endoscopic pyloromyotomy in gastroparesis worldwide

Mekaroonkamol

Shah

Cai

2019

WJG

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Per oral endoscopic pyloromyotomy (POP), also known as gastric per-oral endoscopic myotomy (GPOEM), is a novel procedure with promising potential for the treatment of gastroparesis. As more data emerge and the procedure is becoming more recognized in clinical practice, its safety and efficacy need to be carefully evaluated. Appropriate patient selection for favorable clinical success prediction after GPOEM also needs additional research. This review aims to systemically summarize the existing data on clinical outcomes of POP. Symptomatologic responses to the procedure, its adverse effects, procedural techniques, and predictive factors of clinical success are also discussed.

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“…15 The conventional G-POEM procedure involves a myotomy that is performed through a T A B L E 3 Procedure-related adverse events and days after the procedure before diet was restarted submucosal gastric tunnel. 21,22 In comparison, open POEM (O-POEM) involves a myotomy that is performed under direct endoscopic visualization of the involved muscle layer without submucosal tunneling.…”

Section: Discussionmentioning

confidence: 99%

“…As such, G‐POEM as a treatment for refractory gastroparesis has gradually been recognized and adopted 15 . The conventional G‐POEM procedure involves a myotomy that is performed through a submucosal gastric tunnel 21,22 . In comparison, open POEM (O‐POEM) involves a myotomy that is performed under direct endoscopic visualization of the involved muscle layer without submucosal tunneling.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of prophylactic gastric open peroral endoscopic myotomy for prevention of post‐ESD stenosis: A case series (with video)

Lee

Song

Kim

et al. 2022

J of Digest Diseases

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Endoscopic resection of over 3/4 of the lumen of the antrum or pylorus is a known risk factor for post-endoscopic submucosal dissection (ESD) stenosis. Local or systemic steroids may reduce the risk of stenosis, but their overall role in stenosis prevention remains controversial. We aimed to evaluate the efficacy and safety of prophylactic gastric open peroral endoscopic myotomy (GO-POEM) in preventing post-ESD stenosis. Methods: Ten patients who underwent GO-POEM during or immediately after ESD in the Presbyterian Medical Center between June 2017 and November 2020 were included. All patients underwent excision of over 3/4 of the lumen of the antrum or pylorus. GO-POEM was performed without submucosal tunneling.Results: Well-differentiated tubular adenocarcinoma, tubulovillous adenoma with high-grade dysplasia, and tubular adenoma with low-grade dysplasia were diagnosed in three, one, and six patients, respectively. GO-POEM was performed successfully in all the 10 patients. Stenosis could not be evaluated in one patient, whereas one of the remaining nine patients developed post-ESD stenosis. GO-POEM decreased the risk of post-ESD stenosis in the other eight patients. Two patients presented with intraprocedural bleeding, both of whom were managed endoscopically successfully.Conclusions: Prophylactic GO-POEM may be a novel, effective and safe treatment modality for preventing post-ESD stenosis in the stomach. Well-designed, multicenter studies with large sample sizes are needed to confirm our results.

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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

Abstract: 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.

Cited by 15 publications

References 38 publications

Gastric peroral endoscopic pyloromyotomy versus gastric electrical stimulation in the treatment of refractory gastroparesis: a propensity score-matched analysis of long term outcomes

Gastric peroral endoscopic pyloromyotomy versus gastric electrical stimulation in the treatment of refractory gastroparesis: a propensity score-matched analysis of long term outcomes

Outcomes of per oral endoscopic pyloromyotomy in gastroparesis worldwide

Safety and efficacy of prophylactic gastric open peroral endoscopic myotomy for prevention of post‐ESD stenosis: A case series (with video)

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