Comprehensive Analysis of Adverse Events Associated with Gastric Peroral Endoscopic Myotomy: An International Multicenter Study

Ichkhanian, Yervant; Vosoughi, Kia; Meybodi, M. Aghaie; Jacques, Jérémie; Sethi, Amrita; Patel, Amit A.; Aadam, A. Aziz; Triggs, Joseph; Bapaye, Amol; Dorwat, Shivangi; Benias, Petros C.; Chaves, Dalton Marques; Barret, Maximilien; Law, Ryan; Browers, N.; Pioche, Mathieu; Draganov, Peter V.; Kotzev, Andrey; Estremera, Fermín; Albéniz, Eduardo; Ujiki, Michael; Callahan, Zachary M.; Itani, Mohamad I.; Brewer, Olaya; Khashab, Mouen A.

doi:10.1007/s00464-020-07570-z

Cited by 22 publications

(26 citation statements)

References 24 publications

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“…If only the gastric or duodenal wall is perforated and the gallbladder is still intact, immediate endoscopic closure with an over-the-scope (OTS) clip can be considered. If endoscopic salvage has been successfully performed, capnoperitoneum can usually be treated conservatively, but transabdominal needle decompression may be required in cases of tension capnoperitoneum [111].…”

Section: Stone Clearance and Lams Replacementmentioning

confidence: 99%

Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review

et al. 2022

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Main Recommendations 1 ESGE recommends a prolonged course of a prophylactic broad-spectrum antibiotic in patients with ascites who are undergoing therapeutic endoscopic ultrasound (EUS) procedures.Strong recommendation, low quality evidence. 2 ESGE recommends placement of partially or fully covered self-expandable metal stents during EUS-guided hepaticogastrostomy for biliary drainage in malignant disease.Strong recommendation, moderate quality evidence. 3 ESGE recommends EUS-guided pancreatic duct (PD) drainage should only be performed in high volume expert centers, owing to the complexity of this technique and the high risk of adverse events.Strong recommendation, low quality evidence. 4 ESGE recommends a stepwise approach to EUS-guided PD drainage in patients with favorable anatomy, starting with rendezvous-assisted endoscopic retrograde pancreatography (RV-ERP), followed by antegrade or transmural drainage only when RV-ERP fails or is not feasible.Strong recommendation, low quality evidence. 5 ESGE suggests performing transduodenal EUS-guided gallbladder drainage with a lumen-apposing metal stent (LAMS), rather than using the transgastric route, as this may reduce the risk of stent dysfunction.Weak recommendation, low quality evidence. 6 ESGE recommends using saline instillation for small-bowel distension during EUS-guided gastroenterostomy.Strong recommendation, low quality evidence. 7 ESGE recommends the use of saline instillation with a 19G needle and an electrocautery-enhanced LAMS for EUS-directed transgastric endoscopic retrograde cholangiopancreatography (EDGE) procedures.Strong recommendation, low quality evidence. 8 ESGE recommends the use of either 15- or 20-mm LAMSs for EDGE, with a preference for 20-mm LAMSs when considering a same-session ERCP.Strong recommendation, low quality evidence.

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Section: Stone Clearance and Lams Replacementmentioning

confidence: 99%

Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review

et al. 2022

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“…However, EsoFLIP might resemble a valuable alternative to G-POEM, which is available in few centers, is technically challenging, and is still considered experimental, per European Society of Gastrointestinal Endoscopy guidelines. 7 Despite having a rather favorable safety profile, the technically highly complex G-POEM procedures are associated with moderate and severe rates of adverse events of 16% and 6%, respectively, with significantly higher rates for less-experienced endoscopists, 35 usually leading to procedures conducted in specialized tertiary centers. Because of the possibility of adverse events, patients are usually monitored for a few days in the hospital.…”

Section: T0mentioning

confidence: 99%

Pyloric dilation with the esophageal functional lumen imaging probe in gastroparesis improves gastric emptying, pyloric distensibility, and symptoms

Murray

Schindler

Hente

et al. 2021

Gastrointestinal Endoscopy

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Background and Aims: The role of decreased pyloric distensibility in gastroparesis as measured by the endolumenal functional luminal imaging probe (EndoFLIP) has been receiving increasing attention. In this study, we present clinical outcomes to pyloric dilation with the esophageal FLIP (EsoFLIP) in regard to gastric emptying, symptom evolution, and FLIP metrics.Methods: Patients evaluated for gastroparesis (gastric emptying studies of t 1/2 !180 minutes during 13 C-octanoic acid breath test and/or gastric remnants during gastroscopy after a sufficient fasting period) were scheduled for EsoFLIP controlled pyloric dilation. Pre-and postprocedural gastric emptying studies, questionnaires (Patient Assessment of Upper GI Symptoms Severity Index [PAGI-SYM; including the Gastroparesis Cardinal Symptom Index] and Patient Assessment of Quality of Life Index [PAGI-QOL]), and FLIP metrics were documented. Dilation was conducted according to a self-developed algorithm.Results: Forty-six patients were analyzed (72% women; median age, 39 years [range, 18-88]). Etiologies of gastroparesis were diabetic in 10 patients (22%), idiopathic in 33 (72%), and postoperative in 3 (6%). Postprocedural gastric emptying time decreased from a median of 211 minutes to 179 minutes (P Z .001). In accordance, pyloric distensibility, PAGI-SYM, PAGI-QOL, and Gastroparesis Cardinal Symptom Index values improved significantly. After a median follow-up of 3.9 months, 57% of all treated patients with returned questionnaires reported improved symptoms.Conclusions: Pyloric EsoFLIP controlled dilation shows value in the treatment of gastroparesis, both subjectively and objectively. Long-term follow-up to assess efficacy and comparative trials are warranted. (Gastrointest Endosc 2021;-:1-9.) Gastroparesis is a debilitating condition, associated with a significant increase in healthcare costs and a reduction in annual income for affected patients. 1 Although its pathophysiology is complex and not fully understood, pharmacologic treatment options are limited by side effects, questionable efficacy, and/or off-label status. 2

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“…[6][7][8] Post-ESD stenosis was assessed when an ulcer scar was noted over the ESD any procedure-related event that required cessation of the procedure and/or led to an additional medical consultation, diagnostic examination, intervention, surgery, or prolonged hospital stay. 17 The severity of AEs was evaluated based on the American Society for Gastrointestinal Endoscopy (ASGE) severity grading system. 18 AEs were classified as intraprocedural, early (during the first 48 h after the procedure) and late (after 48 h) postprocedural AEs.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of prophylactic gastric open peroral endoscopic myotomy for prevention of post‐ESD stenosis: A case series (with video)

Lee

Song

Kim

et al. 2022

J of Digest Diseases

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Endoscopic resection of over 3/4 of the lumen of the antrum or pylorus is a known risk factor for post-endoscopic submucosal dissection (ESD) stenosis. Local or systemic steroids may reduce the risk of stenosis, but their overall role in stenosis prevention remains controversial. We aimed to evaluate the efficacy and safety of prophylactic gastric open peroral endoscopic myotomy (GO-POEM) in preventing post-ESD stenosis. Methods: Ten patients who underwent GO-POEM during or immediately after ESD in the Presbyterian Medical Center between June 2017 and November 2020 were included. All patients underwent excision of over 3/4 of the lumen of the antrum or pylorus. GO-POEM was performed without submucosal tunneling.Results: Well-differentiated tubular adenocarcinoma, tubulovillous adenoma with high-grade dysplasia, and tubular adenoma with low-grade dysplasia were diagnosed in three, one, and six patients, respectively. GO-POEM was performed successfully in all the 10 patients. Stenosis could not be evaluated in one patient, whereas one of the remaining nine patients developed post-ESD stenosis. GO-POEM decreased the risk of post-ESD stenosis in the other eight patients. Two patients presented with intraprocedural bleeding, both of whom were managed endoscopically successfully.Conclusions: Prophylactic GO-POEM may be a novel, effective and safe treatment modality for preventing post-ESD stenosis in the stomach. Well-designed, multicenter studies with large sample sizes are needed to confirm our results.

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Comprehensive Analysis of Adverse Events Associated with Gastric Peroral Endoscopic Myotomy: An International Multicenter Study

Cited by 22 publications

References 24 publications

Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review

Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review

Pyloric dilation with the esophageal functional lumen imaging probe in gastroparesis improves gastric emptying, pyloric distensibility, and symptoms

Safety and efficacy of prophylactic gastric open peroral endoscopic myotomy for prevention of post‐ESD stenosis: A case series (with video)

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