Gastric per-oral endoscopic pyloromyotomy in the treatment of refractory gastroparesis: Report on the first case performed in Mexico

Hernández-Mondragón, O.V.; Solórzano-Pineda, O.M.; Blancas-Valencia, Juan Manuel; González-Martínez, M.A.; Villanueva-Pérez, R.M.

doi:10.1016/j.rgmxen.2017.08.003

Cited by 5 publications

(8 citation statements)

References 8 publications

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“…Therefore, we used postoperative fasting time to reflect the postoperative recovery. Mean postsurgical fasting time (2.23 ± 0.44 days) was similar to the postoperative recovery of other studies (often represented by hospital stay) [ 10 – 17 , 31 – 35 ].…”

Section: Discussionsupporting

confidence: 83%

“…The first clinical application was successful in the following year [ 10 ]. After that, G-POEM was gradually used to treat refractory gastroparesis [ 10 – 17 , 31 – 35 ].…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, peroral endoscopic myotomy (POEM) had been successfully applicated in the treatment of achalasia. Based on the theory of POEM, gastric peroral endoscopic myotomy (G-POEM) was gradually performed in the therapy of gastroparesis [ 10 – 17 ]. Nevertheless, there was few study about G-POEM in the therapy of postsurgical gastroparesis.…”

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confidence: 99%

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Feasibility, safety, and long-term efficacy of gastric peroral endoscopic myotomy (G-POEM) for postsurgical gastroparesis: a single-center and retrospective study of a prospective database

et al. 2020

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Background Postsurgical gastroparesis is recognized as a gastrointestinal dysfunction syndrome following foregut surgery. Gastric peroral endoscopic myotomy (G-POEM) is suggested as a minimally invasive therapy for gastroparesis. But the long-term efficacy and safety of G-POEM in treating postsurgical gastroparesis are rarely explored. Methods The primary outcomes included the symptomatic improvement based on gastroparesis cardinal symptoms index (GCSI) and the improvement of gastric emptying. The secondary outcomes included the improvement of gastroesophageal reflux symptoms and complications of G-POEM. Results The severity of postsurgical gastroparesis was not associated with the onset time and the course of the disease. G-POEM significantly reduced GCSI throughout the follow-up period (p < 0.0001). For different anastomotic site, a significant improvement of GCSI was found at 6 month post-G-POEM (F 4,165 = 74.18, p < 0.0001). Subscale analysis of GCSI showed that nausea/vomiting, post-prandial fullness/early satiety, and bloating were improved significantly at 6-month post-G-POEM (p < 0.0001, respectively). Half-emptying and whole-emptying time were significantly shortened in patients with different anastomotic site post-G-POEM (half-emptying time: F 3,174 = 65.44, p < 0.0001; whole-emptying time: F 3,174 = 54.85, p < 0.0001). The emptying of ioversol was obviously accelerated after G-POEM. GCSI wasn't related to pyloric length, pyloric diameter, and thickness of pyloric wall. GERDQ was also used to evaluate the clinical efficacy of G-POEM. For each time points, GERDQ didn't differ significantly in patients with different anastomotic site (F 4,104 = 0.8075, p = 0.5231). For patients with different anastomotic site, GERDQ was improved significantly at different time points (F 4,104 = 59.11, p < 0.0001). The higher the esophageal anastomotic site was, the faster G-POEM improved the symptoms of gastroesophageal reflux. No one required re-hospitalization for any complication. Conclusion G-POEM is a minimally invasive therapy with long-term effectiveness and safety in treating postsurgical gastroparesis. Keywords G-POEM • Postsurgical gastroparesis • GCSI • GERDQ • The anastomotic site • Gastric emptying Postsurgical gastroparesis refers to the gastrointestinal dysfunction syndrome that occurs after esophageal and gastrointestinal surgery and other surgical operations affecting the

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Section: Discussionsupporting

confidence: 83%

“…The first clinical application was successful in the following year [ 10 ]. After that, G-POEM was gradually used to treat refractory gastroparesis [ 10 – 17 , 31 – 35 ].…”

Section: Discussionmentioning

confidence: 99%

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Feasibility, safety, and long-term efficacy of gastric peroral endoscopic myotomy (G-POEM) for postsurgical gastroparesis: a single-center and retrospective study of a prospective database

et al. 2020

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“…Clinical outcomes have been reported in about 130 patients in 5 studies [ 2 , 16 , 19 - 21 ]. All studies were retrospective, and there has been no prospective study or randomized controlled trial ( Table 1 ).…”

Section: G-poemmentioning

confidence: 99%

Gastric Peroral Endoscopic Myotomy

Lee

Khashab

2018

Clin Endosc

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Gastroparesis (GP) is a syndrome characterized by delayed gastric emptying in the absence of mechanical obstruction of the stomach or proximal small bowel. Currently available dietary and medical therapies are limited and have suboptimal efficacy. Pylorus-directed therapies have showed promising results. Gastric peroral endoscopic myotomy (G-POEM) has been reported for the treatment of GP refractory to standard therapy with promising results. This article reviews the current applications and results of G-POEM for the treatment of refractory GP.

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“…In 2013, was described the first G-POEM case in humans that failed medical therapy but responded well to transpyloric stent. Since then, multiple studies and literature reviews have proved its safety and efficacy and shown its improvement in the clinical symptoms of gastroparesis 5–28. It is a technically complex procedure that requires advanced endoscopic skills.…”

mentioning

confidence: 99%

Gastric Peroral Endoscopic Myotomy

Reja

Mishra

Tyberg

et al. 2021

Journal of Clinical Gastroenterology

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Introduction: Gastric peroral endoscopic pyloromyotomy (G-POEM) is a novel option for patients with gastroparesis. It involves submucosal tunneling across the pylorus, followed by pyloromyotomy, and subsequent closure of the endoscopic tunnel. The aim of this study was to determine the learning curve for G-POEM. Methods: Consecutive patients undergoing G-POEM by a single operator were included from a prospective registry over 2 years. Demographics, procedure info, postprocedure follow-up data, and adverse events were collected. Nonlinear regression and cumulative sum control chart analyses were conducted for the learning curve. Clinical outcomes were improvement in Gastroparesis Cardinal Symptom Index score and gastric emptying scintigraphy. Results: Thirty-six patients were included (16.7% M, mean age 46 y). The majority had idiopathic gastroparesis (n=16, 44%), with the remaining having diabetes (n=5, 17%), postsurgical (n=10, 28%), or other (n=4, 11%). Technical success was achieved in 35 of 36 (97%). There was a significant reduction in the total Gastroparesis Cardinal Symptom Index score (2.09 units, P<0.00001) and a significant reduction in postoperative gastric emptying scintigraphy (82.44 mins, P<0.00001). Mean follow-up was 15 months (SD, 1.05). Median procedure time was 60.5 minutes (range, 35 to 136). Cumulative sum control chart shows 60-minute procedure was achieved at the 18th procedure. Procedure durations further reduced with consequent procedures with the last 3 being 45 minutes, thus demonstrating continued improvement with ongoing experience (nonlinear regression P<0.0001). Conclusion: Endoscopists experienced in G-POEM are expected to achieve a reduction in procedure time over successive cases, with efficiency reached at 60.5 minutes and a learning rate of 18 cases with continuing improvement.

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Gastric per-oral endoscopic pyloromyotomy in the treatment of refractory gastroparesis: Report on the first case performed in Mexico

Cited by 5 publications

References 8 publications

Feasibility, safety, and long-term efficacy of gastric peroral endoscopic myotomy (G-POEM) for postsurgical gastroparesis: a single-center and retrospective study of a prospective database

Feasibility, safety, and long-term efficacy of gastric peroral endoscopic myotomy (G-POEM) for postsurgical gastroparesis: a single-center and retrospective study of a prospective database

Gastric Peroral Endoscopic Myotomy

Gastric Peroral Endoscopic Myotomy

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