Fluoroscopy-guided gastric peroral endoscopic pyloromyotomy (G-POEM): a more reliable and efficient method for treatment of refractory gastroparesis

Xue, Hanbing; Fan, Hao; Meng, Xia; Cristofaro, Sarah; Mekaroonkamol, Parit; Dacha, Sunil; Li, Lianyong; Fu, Xiaolin; Zhan, SR; Cai, Qiang

doi:10.1007/s00464-017-5524-y

Cited by 51 publications

(51 citation statements)

References 22 publications

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“…Another aspect of the treatment of gastroparesis is the emerging area of pyloric therapies . Without evidence based data on the role of pyloric therapy for gastroparesis, it is difficult to know how this approach may have changed the outcome of the patients in this study.…”

Section: Discussionmentioning

confidence: 99%

“…45 Another aspect of the treatment of gastroparesis is the emerging area of pyloric therapies. [46][47][48][49][50] thus, with the current approach to pyloric therapy, would not have been considered for that intervention. In terms of GES and pyloric therapy, recent publication has presented an algorithmic approach that could be considered as a way to integrate GES and pyloric (and other) therapies.…”

Section: Discussionmentioning

confidence: 99%

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Effectiveness of gastric electrical stimulation in gastroparesis: Results from a large prospectively collected database of national gastroparesis registries

Abell

Yamada

McCallum

et al. 2019

Neurogastroenterology Motil

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Background Gastric electrical stimulation (GES) for treating gastroparesis symptoms is controversial. Methods We studied 319 idiopathic or diabetic gastroparesis symptom patients from the Gastroparesis Clinical Research Consortium (GpCRC) observational studies: 238 without GES and 81 with GES. We assessed the effects of GES using change in GCSI total score and nausea/vomiting subscales between baseline and 48 weeks. We used propensity score methods to control for imbalances in patient characteristics between comparison groups. Key Results GES patients were clinically worse (40% severe vs. 18% for non‐GES; P < .001); worse PAGI‐QOL (2.2. vs. 2.6; P = .003); and worse GCSI total scores (3.5 vs. 2.8; P < .001). We observed improvements in 48‐week GCSI total scores for GES vs. non‐GES: improvement by ≥ 1‐point (RR = 1.63; 95% CI = (1.14, 2.33); P = .01) and change from enrollment (difference = −0.5 (−0.8, −0.3); P < .001). When adjusting for patient characteristics, symptom scores were smaller and not statistically significant: improvement by ≥ 1‐point (RR = 1.29 (0.88, 1.90); P = .20) and change from the enrollment (difference = −0.3 (−0.6, 0.0); P = .07). Of the individual items, the nausea improved by ≥ 1 point (RR = 1.31 (1.03, 1.67); P = .04). Patients with GCSI score ≥ 3.0 tended to improve more than those with score < 3.0. (Adjusted P = 0.02). Conclusions and Inferences This multicenter study of gastroparesis patients found significant improvements in gastroparesis symptoms among GES patients. Accounting for imbalances in patient characteristics, only nausea remained significant. Patients with greater symptoms at baseline improved more after GES. A much larger sample of patients is needed to fully evaluate symptomatic responses and to identify patients likely to respond to GES.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effectiveness of gastric electrical stimulation in gastroparesis: Results from a large prospectively collected database of national gastroparesis registries

Abell

Yamada

McCallum

et al. 2019

Neurogastroenterology Motil

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“…30 An additional factor is the emergence of pyloric therapies for gastroparesis over the last 5 years. 31,32 Although not yet defined, the presence of systemic inflammation might indicate that the occurrence of pyloric dysfunction, including fibrosis, and resultant delayed gastric emptying, might be a secondary consequence of inflammation at the local GI tract level.…”

Section: Anatomic-mucosal Neuronal Density Vs Full-thickness Biopsymentioning

confidence: 99%

Gastroparesis syndromes: Response to electrical stimulation

Abell

Kedar

Stocker

et al. 2019

Neurogastroenterology Motil

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Background and Aims Factors underlying gastroparesis are not well defined, nor is the mechanism of action of gastric electrical stimulation (GES). We hypothesized that GES acts via several mechanisms related to underlying disordered pathophysiology. Methods We studied 43 consecutive eligible patients with gastroparetic symptoms, previously evaluated by two methods in each of five core areas: inflammatory, autonomic, enteric, electrophysiologic, and hormonal; and also categorized by GI symptoms, metabolic status, illness quantification, and gastric physiology. We then studied 41 patients who underwent temporary GES for 5‐7 days. Thirty‐six of those patients were implanted and 30 were followed up at 6 months after permanent GES. Results In previous but separately reported work, patients had similar GI symptoms regardless of baseline gastric emptying or diabetic/idiopathic status and all patients demonstrated abnormalities in each of the five areas studied. After GES, patients showed early and late effects of electrical stimulation with changes noted in multiple areas, categorized by improvement status. Conclusion Patients with symptoms of gastroparesis have multiple abnormalities, including systemic inflammation and disordered hormonal status. GES affects many of these abnormalities. We conclude electrical stimulation improves symptoms and physiology with (a) an early and sustained anti‐emetic effect; (b) an early and durable gastric prokinetic effect in delayed emptying patients; (c) an early anti‐arrhythmic effect that continues over time; (d) a late autonomic effect; (e) a late hormonal effect; (f) an early anti‐inflammatory effect that persists; and (g) an early and sustained improvement in health‐related quality of life. This study is registered with Clinicaltrials.gov under study # NCT03178370 (https://clinicaltrials.gov/ct2/show/NCT03178370).

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“…Third-space endoscopy has emerged as a novel and effective method for the treatment of different gastrointestinal disorders such as achalasia and refractory gastroparesis [1][2][3][4]. However, difficult or incomplete myotomy has been identified in peroral endoscopy myotomy (POEM) and gastric-peroral endoscopy myotomy (G-POEM) as a result of different factors such as end-stage disease or previously treated cases (due to high submucosal fibrosis) [1,5], inability to identify the esophagogastric junction (EGJ) throughout the submucosal tunnel during POEM [6][7][8] or the pyloric muscle ring (PMR) during G-POEM [9], lack of third-space endoscopy experience [2,3,6], and certain anatomical factors (megaesophagus, sigmoid-type) [4,9,10]. These factors are associated with a failed procedure.…”

Section: Introductionmentioning

confidence: 99%

“…Different techniques, such as fluoroscopy [9,11] or double endoscopy [12,13] have been proposed to overcome these problems and guide an appropriate tunnel creation and myotomy; however, low availability and high costs limit their use.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of Using an Led-Probe in Third-Space Endoscopy: A Clinical Study

Hernández-Mondragón

Mottú

Pineda

et al. 2020

Preprint

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Background and aims: Third-space endoscopy is a novel, safe, and effective method for treating different gastrointestinal conditions. However, several failed endoscopic procedures are attributed to incomplete myotomy. Lighting devices are used to prevent organic injuries. We aimed to investigate the feasibility of using a hand-made LED-probe (LP) in third-space procedures.Patients and Methods: This prospective study was conducted in a tertiary-care center in Mexico between December 2016 and January 2019. We included peroral endoscopic myotomy (POEM) and gastric peroral endoscopic myotomy(G-POEM) procedures. Pseudoachalasia, peptic ulcer, normal gastric emptying scintigraphy (GES) and prepyloric tumors were excluded. LP was used to guide or confirm procedures. Clinical and procedural characteristics were recorded and analyzed.Results: Seventy third-space procedures were included (42POEM,28G-POEM), with an average patient age of 46.7±14.3 and 43.7±10.1 years, respectively. For the POEM and G-POEM groups, respectively, 18/42(42.9%) and 13/28(46.7%) patients were males; median procedure times were 50 (interquartile range[IQR]: 38-71) and 60(IQR: 48-77) min, median LP placement times were 5(IQR: 4-6) and 6(IQR: 5-7) min, mild adverse events occurred in 4(9.4%) and 4(14.2%) of cases, and clinical success at 6 months occurred in 100% and 85.7% of cases. Integrated relaxation pressure (IRP) improved from 27.3±10.8 to 9.5±4.1 mmHg (p<0.001); retention percentage at 4 hours also improved. LP was successfully placed and adequate myotomy confirmed including 14.2% and 17.8% of POEM and G-POEM difficult patients. Conclusions: Using an LP is promising and allows guiding during third-space procedures either for submucosal tunnel creation or myotomy confirmation, with excellent safety and efficacy in clinical practice.

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Fluoroscopy-guided gastric peroral endoscopic pyloromyotomy (G-POEM): a more reliable and efficient method for treatment of refractory gastroparesis

Abstract: Fluoroscopy-guided G-POEM by placement of an endoclip at the pylorus was a reliable and safe method to direct the orientation of the submucosal tunnel, to facilitate the location of the PMR, and to shorten the procedure time.

Cited by 51 publications

References 22 publications

Effectiveness of gastric electrical stimulation in gastroparesis: Results from a large prospectively collected database of national gastroparesis registries

Effectiveness of gastric electrical stimulation in gastroparesis: Results from a large prospectively collected database of national gastroparesis registries

Gastroparesis syndromes: Response to electrical stimulation

Feasibility of Using an Led-Probe in Third-Space Endoscopy: A Clinical Study

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