State of the art review with literature summary on gastric peroral endoscopic pyloromyotomy for gastroparesis

Abstract

Gastroparesis is a debilitating progressive disease that significantly impacts a patient's life with limited and challenging treatments available. Although the pathogenesis is multifactorial, pylorospasm is believed to have a major underlying role. Several therapeutic interventions directed to the pylorus have been developed over the last decade, including intra-pyloric injections of botulinum toxin, transpyloric stenting, and surgical pyloroplasty. All of these treatment options had limited and disappointing results. More recently, gastric peroral endoscopic myotomy (G-POEM) has been reported as a treatment for refractory gastroparesis. In this review article, we provide an overview on gastroparesis with a focus on the therapeutic interventions. In addition, we provide a literature summary and pool analysis of the clinical efficacy, scintigraphic efficacy, and safety profile of all studies that evaluated G-POEM in gastroparesis. Overall, seven studies have reported on the use of G-POEM in gastroparesis, and the pooled analysis of these studies showed a technical success of 100%, with clinical efficacy as assessed by the Gastroparesis Cardinal Symptoms Index of 81.5%, gastric emptying scintigraphy normalization in approximately 55.5% of the cases, perioperative complications in 7.6%, and intraoperative complications in 6.6%. This suggests that G-POEM is a new promising therapeutic intervention for the treatment of gastroparesis with durable effect and limited potential adverse events.

Endoscopic management of gastrointestinal motility disorders – part 1: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

“…Endoflip technology might be a tool for the selection of appropriate patients in the future, but more research is needed. Short-term clinical success at 3 months (defined as a significant improvement in GCSI) has been reported in 73 % -90 % of patients with refractory gastroparesis undergoing G-POEM [150]. Long-term data are missing and the recurrence rate is not known.…”

Practical management approach to gastroparesis

“…Gastric per oral endoscopic myotomy (G-POEM) is an endoscopic technique in which a longitudinal incision is created in the circular smooth muscle of the pylorus, typically between 1.5-2 cm. 53 G-POEM is the latest evolution in interventional procedures which target pylorospasm. Prior to G-POEM, the more invasive surgical pyloroplasty has been shown to improve symptoms and gastric emptying in gastroparesis and underpins the theoretical basis of G-POEM.…”

Establishing a submucosal endoscopy program in a gastrointestinal unit

“…Given its value and clinical success, variations of POEM are emerging and have shown promise in endoscopic management of similar difficult conditions including refractory gastroparesis, oesophageal and Zenker's diverticulum, and reflux post-POEM. In a review of seven studies on G-POEM, Khoury et al 39 have reported technical success in 100% of cases, clinical efficacy in 81.5% and normalisation of measures in gastric emptying studies in 55.5% of cases, with complications between 6.6% and 7.6%. The findings support its efficacy and use in the treatment of gastroparesis after failure of conventional therapy.…”