Gastric peroral endoscopic myotomy for the treatment of refractory gastroparesis: a prospective single-center experience with mid-term follow-up (with video)

Gregor, Lennon; Wo, John M.; DeWitt, John; Yim, Brandon; Siwiec, Robert M.; Nowak, Thomas; Mendez, Martha; Gupta, Anita; Dickason, Destenee; Stainko, Sarah; Al‐Haddad, Mohammad

doi:10.1016/j.gie.2020.12.030

Cited by 41 publications

(67 citation statements)

References 18 publications

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“…Per-oral endoscopic pyloromyotomy or gastric POEM (G-POEM) is a recent addition to the endoscopic armamentarium for the management of refractory gastroparesis. [44][45][46][47] Overall, the pooled clinical response rate of G-POEM in the initial studies was 84% (95% CI: 77-89%). 48 However, the limitations of the initial studies include small sample size, retrospective design, and short follow-up periods.…”

Section: Gastric Per-oral Endoscopic Myotomymentioning

confidence: 98%

Third-Space Endoscopy: Recent Updates

Nabi

Reddy

2021

Journal of Digestive Endoscopy

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Third space or submucosal space is a potential space which on expansion allows the endoscopist to execute a multitude of therapeutic procedures for various gastrointestinal diseases like achalasia, subepithelial tumors, Zenker’s diverticulum, and refractory gastroparesis. Third space was first utilized for performing endoscopic myotomy in cases with achalasia cardia about a decade ago. Since then, the field of submucosal endoscopy has witnessed an exponential growth. The present review focuses on recent advances in the field of third-space endoscopy. With regard to per-oral endoscopic myotomy (POEM) in achalasia cardia, several recent studies have evaluated the long-term outcomes of POEM, compared endoscopic myotomy with pneumatic dilatation (PD) and surgical myotomy, and evaluated the outcomes of short- versus long-esophageal myotomy. In addition, the utility of multiple dose antibiotic prophylaxis to prevent infections after POEM has been questioned. Overall, the results from these studies indicate that POEM is a durable treatment modality, equally effective to Heller’s myotomy and superior to PD. With regard to gastric-POEM (G-POEM), recent studies suggest only modest efficacy in cases with refractory gastroparesis. Therefore, quality studies are required to identify predictors of response to optimize the outcomes of G-POEM in these cases. Another third-space endoscopy procedure that has gained popularity is endoscopic division of septum in cases with esophageal diverticula including Zenker’s POEM and epiphrenic diverticula POEM (Z-POEM and D-POEM, respectively). The technique of diverticulotomy using the principles of submucosal endoscopy appears safe and effective in short term. Data on term outcomes are awaited and comparative trials with flexible endoscopic myotomy required. Per-rectal endoscopic myotomy (PREM) is the most recent addition to third space endoscopy procedures for the management of short-segment Hirschsprung’s disease. Limited data suggest that PREM may be a promising alternative surgery in these cases. However, quality studies with long-term follow-up are required to validate the outcomes of PREM.

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Section: Gastric Per-oral Endoscopic Myotomymentioning

confidence: 98%

Third-Space Endoscopy: Recent Updates

Nabi

Reddy

2021

Journal of Digestive Endoscopy

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“…Other studies have also shown sub-optimal agreement in grading colorectal dysplasia 17 , 18 . Despite this, the most recent guidelines from the European Society of Gastrointestinal Endoscopy (ESGE), as well as those from the US multi-society task force on CRC, continue to recommend surveillance for polyps with high-grade dysplasia regardless of their size 13 , 19 . Patients requiring surveillance after polypectomy include those with complete removal of: at least one adenoma or with high-grade dysplasia; five or more adenomas; any serrated polyp or with dysplasia 13 .…”

Section: Clinical Insightsmentioning

confidence: 99%

CAD systems for colorectal cancer from WSI are still not ready for clinical acceptance

Oliveira

Neto

Fraga³

et al. 2021

Sci Rep

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Most oncological cases can be detected by imaging techniques, but diagnosis is based on pathological assessment of tissue samples. In recent years, the pathology field has evolved to a digital era where tissue samples are digitised and evaluated on screen. As a result, digital pathology opened up many research opportunities, allowing the development of more advanced image processing techniques, as well as artificial intelligence (AI) methodologies. Nevertheless, despite colorectal cancer (CRC) being the second deadliest cancer type worldwide, with increasing incidence rates, the application of AI for CRC diagnosis, particularly on whole-slide images (WSI), is still a young field. In this review, we analyse some relevant works published on this particular task and highlight the limitations that hinder the application of these works in clinical practice. We also empirically investigate the feasibility of using weakly annotated datasets to support the development of computer-aided diagnosis systems for CRC from WSI. Our study underscores the need for large datasets in this field and the use of an appropriate learning methodology to gain the most benefit from partially annotated datasets. The CRC WSI dataset used in this study, containing 1,133 colorectal biopsy and polypectomy samples, is available upon reasonable request.

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“…More recent studies with longer follow-up have evaluated the efficacy of G-POEM. [21][22][23] In this systematic review and meta-analysis, we have evaluated the mid-term efficacy of G-POEM by only including studies with a minimum of 1 year of follow-up.…”

Section: Introductionmentioning

confidence: 99%

Systematic review with meta‐analysis: one‐year outcomes of gastric peroral endoscopic myotomy for refractory gastroparesis

Kamal

Khan

Lee‐Smith

et al. 2021

Aliment Pharmacol Ther

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Background: Several studies have examined the efficacy of gastric peroral endoscopic myotomy (G-POEM) for gastroparesis.Aim: To evaluate the mid-term efficacy of G-POEM by meta-analysis of studies with a minimum 1 year of follow-up. Methods:We reviewed several databases from inception to 10 June 2021 to identify studies that evaluated the efficacy of G-POEM in refractory gastroparesis, and had at least 1 year of follow-up. Our outcomes of interest were clinical success at 1 year, adverse events, difference in mean pre-and 1 year post-procedure Gastroparesis Cardinal Symptom Index (GCSI) score, and difference in mean pre-and post-procedure EndoFLIP measurements. We analysed data using a random-effects model and assessed heterogeneity by I 2 statistic. Results:We included 10 studies comprising 482 patients. Pooled rates (95% CI) of clinical success at 1 year and adverse events were 61% (49%, 71%) and 8% (6%, 11%), respectively. Mean GCSI at 1 year post-procedure was significantly lower than preprocedure; mean difference (MD) (95% CI) −1.4 (−1.9, −0.9). Mean post-procedure distensibility index was significantly higher than pre-procedure in the clinical success group at 40 and 50 mL volume distension; standardised mean difference (95% CI) 0.82 (0.07, 1.64) and 0.91 (0.32, 1.49), respectively. In the clinical failure group, there was no significant difference between mean pre-and post-procedure EndoFLIP measurements.Conclusions: G-POEM is associated with modest clinical success at 1 year. Additional studies with longer follow-up are required to evaluate its longer-term efficacy.

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Gastric peroral endoscopic myotomy for the treatment of refractory gastroparesis: a prospective single-center experience with mid-term follow-up (with video)

Cited by 41 publications

References 18 publications

Third-Space Endoscopy: Recent Updates

Third-Space Endoscopy: Recent Updates

CAD systems for colorectal cancer from WSI are still not ready for clinical acceptance

Systematic review with meta‐analysis: one‐year outcomes of gastric peroral endoscopic myotomy for refractory gastroparesis

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