Gastric peroral endoscopic myotomy for the treatment of refractory gastroparesis: A multicenter international experience

Michel Kahaleh, Jean Michel Gonzalez, Ming Ming Xu, Iman Andalib, Monica Gaidhane, Amy Tyberg, Monica Saumoy, Alberto Jose Baptista Marchena, Marc Barthet

Research output: Contribution to journalArticlepeer-review

38 Scopus citations

Abstract

Background Gastroparesis is a difficult-to-treat motility disorder with a poor response to medical therapy. Gastric peroral endoscopic pyloromyotomy (G-POEM) has been offered as a novel therapy in the treatment of refractory gastroparesis. We present a multicenter case series of our experience with G-POEM. Methods This is an international multicenter case series of patients who underwent G-POEM for the treatment of gastroparesis. The severity of gastroparesis was assessed by delayed gastric emptying scintigraphy (GES) and an elevated gastroparesis cardinal symptoms index (GCSI). Patients then underwent G-POEM using the submucosal tunneling technique. The primary endpoint was improvement in the GCSI score and improvement in gastric emptying on repeat scintigraphy. Secondary endpoints were technical success, complication rate, procedure duration, and length of hospital stay post-procedure. Results G-POEM was technically successful in all 33 patients. Symptomatic improvement was seen in 28/33 patients (85%), with a decrease in symptom score by GCSI from 3.3 to 0.8 at follow-up (P <0.001). The mean procedure duration was 77.6 minutes (37-255 minutes). Mean GES improved significantly from 222.4 minutes to 143.16 minutes (P< 0.001). Complications were minimal and included bleeding (n=1) and an ulcer (n=1) treated conservatively. The mean length of hospital stay post-procedure was 5.4 days (1-14 days). The mean follow-up duration was 11.5 months (2-31 months). Conclusion G-POEM is a technically feasible, safe, and successful procedure for the treatment of refractory gastroparesis. A further multicenter comparative study should be performed to compare this technique to laparoscopic pyloromyotomy.

Original languageEnglish (US)
Pages (from-to)1053-1058
Number of pages6
JournalEndoscopy
Volume50
Issue number11
DOIs
StatePublished - Apr 12 2018

All Science Journal Classification (ASJC) codes

  • Gastroenterology

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