Gastric peroral endoscopic myotomy for refractory gastroparesis: results from the first multicenter study on endoscopic pyloromyotomy (with video).

Gastric peroral endoscopic myotomy for refractory gastroparesis: results from the first multicenter study on endoscopic pyloromyotomy (with video).

Gastrointest Endosc. 2016 Jun 25;

Authors: Khashab MA, Ngamruengphong S, Carr-Locke D, Bapaye A, Benias PC, Serouya S, Dorwat S, Chaves DM, Artifon E, de Moura EG, Kumbhari V, Haito Chavez Y, Bukhari M, Hajiyeva G, Ismail A, Chen YI, Chung H

Abstract
BACKGROUND AND AIMS: Gastric peroral endoscopic myotomy (G-POEM) has been recently reported as minimally invasive therapy for gastroparesis. The aims of this study were to report the first multicenter experience with G-POEM and assess the efficacy and safety of this novel procedure for gastroparetic patients with symptoms refractory to medical therapy.
PATIENTS AND METHODS: All patients with gastroparesis who underwent endoscopic pyloromyotomy (G-POEM) at 5 medical centers were included. Procedures were performed following the same principles as esophageal POEM. Clinical response was defined as improvement in gastroparetic symptoms with absence of recurrent hospitalization. Adverse events (AEs) were graded according to the ASGE lexicon.
RESULTS: A total of 30 patients with refractory gastroparesis (11 diabetic, 12 post-surgical, 7 idiopathic) underwent G-POEM. Prior therapies included Botox injection in 12, transpyloric stenting in 3, and PEGJ in 1. Nausea/vomiting were the predominant symptoms in 25 patients. Weight loss was present in 27 patients with an average of 10% of body weight loss. G-POEM was completed successfully in all 30 (100%) patients with mean procedure time of 72 minutes (range 35-223). The mean myotomy length was 2.6±2.3 cm. The mean length of hospital stay was 3.3 days (range 1-12). Two AEs occurred in 2 (6.7%) patients, including 1 capnoperitoneum and 1 prepyloric ulcer and were rated as mild and severe, respectively. Clinical response was observed in 26 (86%) patients during a median follow-up of 5.5 months. Four patients (2 diabetic, 1 post-surgical, 1 idiopathic etiology) did not respond to G-POEM. Repeat GES was obtained in 17 patients, normalized in 8 (47%) and improved in 6 (35%) patients.
CONCLUSION: G-POEM is a technically feasible procedure. This small non-randomized study suggests the effectiveness of G-POEM for the treatment of patients with gastroparesis refractory to medical therapy. It concomitantly results in normalization of GES in a significant proportion of treated patients.

PMID: 27354102 [PubMed - as supplied by publisher]

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