Gastric Peroral Endoscopic Myotomy

Reja, Mishal; Mishra, Avantika; Tyberg, Amy; Andalib, Iman; Martínez, Guadalupe; Zamarripa, Felipe; Gaidhane, Monica; Nieto, José; Kahaleh, Michel

doi:10.1097/mcg.0000000000001537

Cited by 6 publications

(7 citation statements)

References 30 publications

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“…These results could be reached after a learning curve for endoscopists to carry out the procedure under the best conditions. As such, in a study by Reja et al, operators showed a continuous improvement during the first 18 cases 80 . The mean duration of the procedure was reduced during the learning process.…”

Section: Endoscopic Therapies Targeting the Pylorusmentioning

confidence: 84%

“…As such, in a study by Reja et al, operators showed a continuous improvement during the first 18 cases. 80 The mean duration of the procedure was reduced during the learning process. Moreover, Rodriguez et al suggested that the length of stay could also be reduced by the experience of the center.…”

Section: Endoscopic Therapies Targeting the Pylorusmentioning

confidence: 99%

“…Also, in a study by Reja et al, endoscopists who achieved the learning curve of 18 patients had fewer complications. 80 …”

Section: Efficacy and Safety Of G‐poemmentioning

confidence: 99%

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Targeting the pylorus in gastroparesis: From physiology to endoscopic pyloromyotomy

Soliman

Gourcerol

2023

Neurogastroenterology Motil

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Gastroparesis is defined as delayed gastric emptying (GE) of solid food in the absence of mechanical obstruction. 1 Cardinal symptoms include nausea, vomiting, gastric fullness, early satiety, bloating, and abdominal pain/discomfort. 2 These symptoms can overlap with those of functional dyspepsia, but gastroparesis has to be confirmed by an objective measurement of GE, either by scintigraphy, or by 13 Coctanoic acid breath test. The prevalence of diagnosed gastroparesis has been evaluated in the United States at 0.24% of the population. 3 Recent epidemiological data from the United Kingdom confirm a similar prevalence of 0.13% in Europe based on the diagnostic code, although the disease appears to be underdiagnosed. 4 Gastroparesis leads to an economic burden, evaluated between US$4000 and US$9000 per patient per year in a recent study. 5 Moreover, delayed GE has been associated with increased mortality, independently of age, sex, or the etiology of the disease. 6 The first-line treatment relies on dietary modification and medical treatment, with prokinetic drugs such as metoclopramide. 7,8 However, the efficacy of medical treatment is limited, and up to 40% of patients are considered to be refractory after appropriate treatment. 9 Severe refractory gastroparesis can lead to dehydration, weight loss, and impaired quality of life and could become a challenging condition. 10 Thus, invasive techniques have been developed to improve the symptoms of such patients.Considering the role of pyloric dysfunction in gastroparesis, 11 gastric peroral endoscopic pyloromyotomy (G-POEM) has emerged as an alternative therapeutic technique in patients with refractory gastroparesis. The first human case was described in 2013 by Khashab et al. 12 The technique is based on the principles of peroral endoscopic myotomy of the lower esophageal sphincter, used to treat achalasia. Since then, cohort studies have assessed the clinical efficacy and the safety of G-POEM in refractory gastroparesis.This review aims to detail the role of the pylorus in the pathophysiology of gastroparesis, and then to report the efficacy, modalities, and the place of G-POEM, based on the results of published studies.

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Section: Endoscopic Therapies Targeting the Pylorusmentioning

confidence: 84%

Section: Endoscopic Therapies Targeting the Pylorusmentioning

confidence: 99%

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Targeting the pylorus in gastroparesis: From physiology to endoscopic pyloromyotomy

Soliman

Gourcerol

2023

Neurogastroenterology Motil

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“…The learning curve of the procedure, even in the experts' hands, was estimated to be at 18 procedures. 116 Pyloric parameters such as cross-sectional area and diameter are shown to be inversely associated with cardinal symptoms of postprandial fullness and early satiety. 49 Poor pyloric compliance and distensibility are also associated with severity of gastroparesis symptoms and delayed gastric emptying time.…”

Section: Endoscopic Therapymentioning

confidence: 98%

“…The learning curve of the procedure, even in the experts’ hands, was estimated to be at 18 procedures. 116 …”

Section: Treatmentmentioning

confidence: 99%

A New Paradigm Shift in Gastroparesis Management

2022

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Gastroparesis, once regarded as a rare disease, is difficult to diagnose and challenging to treat; there were many breakthrough advances in the 2010s, shifting the paradigm of the understanding of this complex entity and its management. Similar to diabetes, its increasing prevalence reflects increased accessibility to diagnostic modalities and suggests that gastroparesis was underacknowledged in the past. Major developments in the three main aspects of the disease include the discovery of smooth muscle cells, interstitial cells of Cajal, PDGFRα + cells syncytium, rather than interstitial cells of Cajal alone, as the main gastric pacemaker unit; the development of validated point-of-care diagnostic modalities such as a wireless motility capsule, the carbon 13-labeled breath test, and impedance planimetry; and the introduction of novel minimally invasive therapeutic options such as newer pharmacologic agents and gastric peroral endoscopic pyloromyotomy. All aspects of these advances will be discussed further in this review.

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Long‐term efficacy (at and beyond 1 year) of gastric peroral endoscopic myotomy for refractory gastroparesis: A systematic review and meta‐analysis

Mandarino,

Barchi,

Salmeri

et al. 2024

DEN Open

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IntroductionAlthough gastric peroral endoscopic myotomy (G‐POEM) has shown substantial efficacy in patients with medically refractory gastroparesis (GP), comprehensive long‐term data on its effectiveness are lacking.MethodsWe conducted a systematic review and meta‐analysis including observational studies assessing long‐term efficacy after G‐POEM in patients with refractory GP. Our primary outcome was the pooled rate of clinical success 1‐year after G‐POEM. Secondary outcomes included clinical success at 2 and 3 years and the rate of adverse events according to the American Society for Gastrointestinal Endoscopy classification.ResultsThirteen studies, involving 952 patients with refractory GP undergoing G‐POEM, were eligible. The pooled 1 year‐clinical success was 0.72 (95% confidence interval [CI]: 0.56, 0.85, I2 = 94.9%). The clinical success was 0.67 (95% CI: 0.47, 0.97, I2 = 95.8%) when considering only studies defining success as 1 point decrease in Gastroparesis Cardinal Symptoms Index score and at least 25% decrease in two subscales. For patients who had 1‐year success, the pooled clinical success at 2 and 3 years were 0.71 (95% CI: 0.45, 0.92, I2 = 94.9%) and 0.58 (95% CI: 0.19, 0.92, I2 = 97.1%), respectively. The pooled rate of adverse events was 0.08 (95% CI: 0.06, 0.10, I2 = 0%).ConclusionG‐POEM is associated with successful outcomes in about 70% of treated cases after 1 year, with durable long‐term effects lasting up to 3 years. In the future, new uniform outcome definitions and strict patient selection criteria are warranted to delineate G‐POEM outcomes more accurately.

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Gastric Peroral Endoscopic Myotomy

Cited by 6 publications

References 30 publications

Targeting the pylorus in gastroparesis: From physiology to endoscopic pyloromyotomy

Targeting the pylorus in gastroparesis: From physiology to endoscopic pyloromyotomy

A New Paradigm Shift in Gastroparesis Management

Long‐term efficacy (at and beyond 1 year) of gastric peroral endoscopic myotomy for refractory gastroparesis: A systematic review and meta‐analysis

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