Gastric per-oral endoscopic myotomy (G-POEM) for refractory gastroparesis: results from an international prospective trial

Vosoughi, Kia; Ichkhanian, Yervant; Benias, Petros C.; Miller, Larry S.; Aadam, A. Aziz; Triggs, Joseph; Law, Ryan; Hasler, William L.; Bowers, Nicole; Chaves, Dalton Marques; Neto, Alberto Machado da Ponte; Draganov, Peter V.; Yang, Dennis; Halabi, Maan El; Sanaei, Omid; Gutierrez, Olaya I. Brewer; Bulat, Robert; Pandolfino, John E.; Khashab, Mouen A.

doi:10.1136/gutjnl-2020-322756

Cited by 80 publications

(121 citation statements)

References 45 publications

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“…Gastric peroral endoscopic pyloromyotomy (G-POEM) is emerging as a treatment option worldwide for select patients with refractory gastroparesis. [1][2][3][4] Adverse events may occur up to 14% of the time, with lower rates among experienced endoscopists, supporting the performance of G-POEM in expert centers. 5,6 Technical challenges include ensuring that tunneling is done in the right direction toward the pylorus and identifying the pyloric ring at the end of the tunnel.…”

Section: Introductionmentioning

confidence: 89%

Navigational tunnel technique for gastric peroral endoscopic pyloromyotomy: getting straight to the point (pylorus)

et al. 2022

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Background and Aims: Gastric peroral endoscopic pyloromyotomy (G-POEM) is emerging as a treatment option for patients with gastroparesis. The most technically difficult part of the procedure is creating a submucosal tunnel in the gastric antrum, which can be directionally challenging. We describe a novel navigational tunneling method that guides submucosal dissection in the direction of the pylorus and helps to identify the pyloric landmarks.Methods: Consecutive patients from September to December 2020 who underwent G-POEM for symptomatic gastroparesis were included. All cases were confirmed by prolonged gastric emptying study. The navigational tunnel technique was performed as follows: (1) mucosal cautery markings were made to outline the tunnel starting 3 to 4 cm proximal to the pylorus, (2) submucosal injection was done at the level of the pylorus and extended backward to the incision point, and (3) submucosal dissection was carried out after the prior submucosal injection straight to the pylorus.Results: Six patients with gastroparesis underwent G-POEM with the navigational tunneling technique. The average time for submucosal injection was 2 minutes and 42 seconds, and the average tunnel time was 15 minutes and 36 seconds. There were no adverse events. All patients reported significant improvement (50%-85%) in symptoms.Conclusions: This novel navigational tunneling technique appears to guide and facilitate G-POEM by providing a visual path for submucosal dissection straight to the pylorus. It may increase efficiency, decreasing the need to repeatedly exit the tunnel to check direction and preventing nonproductive wandering. It may also help identify the pyloric ring within the tunnel. (VideoGIE 2021;-:1-3.

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Section: Introductionmentioning

confidence: 89%

Navigational tunnel technique for gastric peroral endoscopic pyloromyotomy: getting straight to the point (pylorus)

et al. 2022

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“…Per-oral endoscopic pyloromyotomy or gastric POEM (G-POEM) is a recent addition to the endoscopic armamentarium for the management of refractory gastroparesis. [44][45][46][47] Overall, the pooled clinical response rate of G-POEM in the initial studies was 84% (95% CI: 77-89%). 48 However, the limitations of the initial studies include small sample size, retrospective design, and short follow-up periods.…”

Section: Gastric Per-oral Endoscopic Myotomymentioning

confidence: 98%

Third-Space Endoscopy: Recent Updates

Nabi

Reddy

2021

Journal of Digestive Endoscopy

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Third space or submucosal space is a potential space which on expansion allows the endoscopist to execute a multitude of therapeutic procedures for various gastrointestinal diseases like achalasia, subepithelial tumors, Zenker’s diverticulum, and refractory gastroparesis. Third space was first utilized for performing endoscopic myotomy in cases with achalasia cardia about a decade ago. Since then, the field of submucosal endoscopy has witnessed an exponential growth. The present review focuses on recent advances in the field of third-space endoscopy. With regard to per-oral endoscopic myotomy (POEM) in achalasia cardia, several recent studies have evaluated the long-term outcomes of POEM, compared endoscopic myotomy with pneumatic dilatation (PD) and surgical myotomy, and evaluated the outcomes of short- versus long-esophageal myotomy. In addition, the utility of multiple dose antibiotic prophylaxis to prevent infections after POEM has been questioned. Overall, the results from these studies indicate that POEM is a durable treatment modality, equally effective to Heller’s myotomy and superior to PD. With regard to gastric-POEM (G-POEM), recent studies suggest only modest efficacy in cases with refractory gastroparesis. Therefore, quality studies are required to identify predictors of response to optimize the outcomes of G-POEM in these cases. Another third-space endoscopy procedure that has gained popularity is endoscopic division of septum in cases with esophageal diverticula including Zenker’s POEM and epiphrenic diverticula POEM (Z-POEM and D-POEM, respectively). The technique of diverticulotomy using the principles of submucosal endoscopy appears safe and effective in short term. Data on term outcomes are awaited and comparative trials with flexible endoscopic myotomy required. Per-rectal endoscopic myotomy (PREM) is the most recent addition to third space endoscopy procedures for the management of short-segment Hirschsprung’s disease. Limited data suggest that PREM may be a promising alternative surgery in these cases. However, quality studies with long-term follow-up are required to validate the outcomes of PREM.

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“…Endoscopic pyloric dilation has been less commonly evaluated in gastroparesis, and not in PD, but could also allow a temporary relief in some patients [95]. Recently, gastric endoscopic pyloromyotomy has been developed for refractory patients, and reveals improvement in gastric emptying and symptomatic scores, with a more sustained relief in 66% of patients at 1 year [96,97]. This technique also has not been assessed in PD, and controlled trials are still missing.…”

Section: Interventional Techniquesmentioning

confidence: 99%

Gastroparesis in Parkinson Disease: Pathophysiology, and Clinical Management

2021

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Patients with Parkinson disease (PD) experience a range of non-motor symptoms, including gastrointestinal symptoms. These symptoms can be present in the prodromal phase of the disease. Recent advances in pathophysiology reveal that α-synuclein aggregates that form Lewy bodies and neurites, the hallmark of PD, are present in the enteric nervous system and may precede motor symptoms. Gastroparesis is one of the gastrointestinal involvements of PD and is characterized by delayed gastric emptying of solid food in the absence of mechanical obstruction. Gastroparesis has been reported in nearly 45% of PD. The cardinal symptoms include early satiety, postprandial fullness, nausea, and vomiting. The diagnosis requires an appropriate test to confirm delayed gastric emptying, such as gastric scintigraphy, or breath test. Gastroparesis can lead to malnutrition and impairment of quality of life. Moreover, it might interfere with the absorption of antiparkinsonian drugs. The treatment includes dietary modifications, and pharmacologic agents both to accelerate gastric emptying and relieve symptoms. Alternative treatments have been recently developed in the management of gastroparesis, and their use in patients with PD will be reported in this review.

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Gastric per-oral endoscopic myotomy (G-POEM) for refractory gastroparesis: results from an international prospective trial

Cited by 80 publications

References 45 publications

Navigational tunnel technique for gastric peroral endoscopic pyloromyotomy: getting straight to the point (pylorus)

Navigational tunnel technique for gastric peroral endoscopic pyloromyotomy: getting straight to the point (pylorus)

Third-Space Endoscopy: Recent Updates

Gastroparesis in Parkinson Disease: Pathophysiology, and Clinical Management

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