Technical Aspects of Peroral Endoscopic Pyloromyotomy

Tao, Jie; Patel, Vaishali; Mekaroonkamol, Parit; Luo, Hui; Li, Baiwen; Guan, Qunye; Shen, Shanshan; Chen, Huimin; Cai, Qiang

doi:10.1016/j.giec.2018.08.012

Cited by 11 publications

(7 citation statements)

References 26 publications

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“…All G‐POEM procedures were performed according to previously reported methods by the same therapeutic endoscopist (author RL) in a single endoscopy suite at University of Michigan Hospital 11,22,23 . To minimize the risk of retained gastric food, all endoscopies were performed after a 3‐day period of a liquid diet.…”

Section: Methodsmentioning

confidence: 99%

“…All G-POEM procedures were performed according to previously reported methods by the same therapeutic endoscopist (author RL) in a single endoscopy suite at University of Michigan Hospital. 11,22,23 To minimize the risk of retained gastric food, all endoscopies were performed after a 3-day period of a liquid diet. Each patient underwent endotracheal intubation and was administered general anesthesia for the duration of the procedure using consistent protocols as deemed appropriate by the attending anesthesiologist.…”

Section: G-poem Protocolsmentioning

confidence: 99%

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Impact of gastric per‐oral endoscopic myotomy on static and dynamic pyloric function in gastroparesis patients

Watts

Baker

Lee

et al. 2020

Neurogastroenterology Motil

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Background: Functional Lumen Imaging Probe (EndoFLIP) tests typically measure static pyloric parameters, but the pylorus exhibits phasic variations on manometry. Dynamic changes in pyloric function have not been quantified using EndoFLIP, and the impact of Gastric Per-Oral Endoscopic Myotomy (G-POEM) on static and dynamic pyloric activity in gastroparesis is unknown. Methods: EndoFLIP balloon inflation to 30, 40, and 50 mL was performed to measure mean, maximum, and minimum values and variability in pyloric diameter and distensibility before and after G-POEM in 20 patients with refractory gastroparesis. The impact of phasic contractions on these pyloric measures was compared. Key Results: G-POEM increased mean (P < .0001) and maximum (P = .0002) pyloric diameters and mean (P = .02) and maximum (P = .02) pyloric distensibility on 50 mL EndoFLIP inflation but not intraballoon pressures or minimum diameters or distensibility. Temporal variability of pyloric diameter (P = .02) and distensibility (P = .02) also increased after G-POEM. Phasic coupled contractions propagating from the antrum through the pylorus were observed in 37.5% of recordings; other phasic activity including isolated pyloric contractions were seen in 23.3%. Variability of pyloric diameter and distensibility tended to be higher during recordings with phasic activity. Some pyloric responses to G-POEM were influenced by age, gastroparesis etiology, gastric emptying, and prior botulinum toxin injection. Conclusions & Inferences: Pyloric activity exhibits dynamic changes on EndoFLIP testing in gastroparesis. G-POEM increases maximal but not minimal diameter and distensibility with increased variations, suggesting this therapy enhances pyloric opening but may not impair pyloric closure. Phasic pyloric contractions contribute to variations in pyloric activity.

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Section: Methodsmentioning

confidence: 99%

Section: G-poem Protocolsmentioning

confidence: 99%

Impact of gastric per‐oral endoscopic myotomy on static and dynamic pyloric function in gastroparesis patients

Watts

Baker

Lee

et al. 2020

Neurogastroenterology Motil

View full text Add to dashboard Cite

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“…Hook knife is favoured by several endoscopists. Additionally, most studies have favoured posterior gastric antral wall or greater curvature instead of anterior wall for submucosal tunnelling 159. Correct identification of pyloric muscle ring and hence the extent of submucosal tunnelling required is often technically challenging.…”

Section: Introductionmentioning

confidence: 99%

Gastroparesis: a turning point in understanding and treatment

Grover

Farrugia

Stanghellini

2019

Gut

192

219

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Gastroparesis is defined by delayed gastric emptying (GE) and symptoms of nausea, vomiting, bloating, postprandial fullness, early satiety and abdominal pain. Most common aetiologies include diabetes, postsurgical and postinfectious, but in many cases it is idiopathic. Clinical presentation and natural history vary by the aetiology. There is significant morbidity and healthcare utilisation associated with gastroparesis. Mechanistic studies from diabetic animal models of delayed GE as well as human full-thickness biopsies have significantly advanced our understanding of this disorder. An innate immune dysregulation and injury to the interstitial cells of Cajal and other components of the enteric nervous system through paracrine and oxidative stress mediators is likely central to the pathogenesis of gastroparesis. Scintigraphy and 13C breath testing provide the most validated assessment of GE. The stagnant gastroparesis therapeutic landscape is likely to soon see significant changes. Relatively newer treatment strategies include antiemetics (aprepitant), prokinetics (prucalopride, relamorelin) and fundic relaxants (acotiamide, buspirone). Endoscopic pyloromyotomy appears promising over the short term, especially for symptoms of nausea and vomiting. Further controlled trials and identification of the appropriate subgroup with pyloric dysfunction and assessment of long-term outcomes are essential. This review highlights the clinical presentation, diagnosis, mechanisms and treatment advancements for gastroparesis.

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“…El G-POEM es una terapia endoscópica reciente de la gastroparesia refractaria. El primer procedimiento se realizó en 2013 y consiste en una disección submucosa del anillo pilórico, la cual ha ganado espacio por su eficacia y seguridad (43). Vosoughi y colaboradores (44) demostraron que la EndoFLIP es una herramienta diagnóstica que permite predecir qué pacientes van a responder a la terapia con G-POEM; al evaluar a 37 pacientes con gastroparesia refractaria de 5 centros, a quienes se les realizó G-POEM y tenían mediciones de EndoFLIP (CSA, presión del balón e índice de distensibilidad), se comparó el éxito clínico al año y el vaciamiento gástrico a los 3 meses, y se encontró que la documentación de la disminución del CSA fue un predictor de éxito posterior a la realización del G-POEM (44).…”

Section: Ergeunclassified

EndoFLIP: una nueva tecnología

Hani

Villarreal

Bejarano

et al. 2021

Rev colomb Gastroenterol

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Mediante la distensión de un balón con líquido conductor, la sonda de imagen luminal funcional endoluminal (EndoFLIP) evalúa las propiedades biomecánicas como la distensibilidad, volumen, presión e inclusive diámetros de regiones esfinterianas como la unión gastroesofágica, píloro y ano. La mayor evidencia en la utilidad clínica de la EndoFLIP está en los trastornos de motilidad esofágica, principalmente para identificar acalasia cuando la manometría esofágica de alta resolución y otras imágenes no logran diagnosticarla e inclusive, mediante el programa de FLIP 2.0, caracteriza la acalasia en subtipos a partir de patrones de motilidad del esófago distal en respuesta a la distensión. Se ha demostrado recientemente que la EndoFLIP tiene un rol diagnóstico, pronóstico o terapéutico en otras patologías como la esofagitis eosinofílica, reflujo gastroesofágico, gastroparesia, durante la fundoplicatura y dilatación esofágica.

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Technical Aspects of Peroral Endoscopic Pyloromyotomy

Cited by 11 publications

References 26 publications

Impact of gastric per‐oral endoscopic myotomy on static and dynamic pyloric function in gastroparesis patients

Impact of gastric per‐oral endoscopic myotomy on static and dynamic pyloric function in gastroparesis patients

Gastroparesis: a turning point in understanding and treatment

EndoFLIP: una nueva tecnología

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