Gastric Peroral Endoscopic Pyloromyotomy for Infants With Congenital Hypertrophic Pyloric Stenosis

Abstract

INTRODUCTION: Congenital hypertrophic pyloric stenosis (CHPS), the most common infantile disease requiring surgical intervention, is routinely treated with open or laparoscopic pyloromyotomy. Recently, gastric peroral endoscopic pyloromyotomy (G-POEM) has been used for adult gastroparesis. We aimed to evaluate the efficacy and safety of G-POEM in treating infantile CHPS. METHODS:We reviewed data from 21 G-POEM-treated patients at 3 tertiary children's endoscopic centers in China between January 2019 and December 2020. Clinical characteristics, procedure-related parameters, perioperative management, and follow-up outcomes were summarized. RESULTS:G-POEM was performed successfully in all patients. The median operative duration was 49 (14-150) minutes. The submucosal tunnels were successfully established along the greater curvature of the stomach in 19 cases, and 2 cases were switched to the lesser curvature because of difficulty. No perioperative major adverse events occurred. Minor adverse events included inconsequential mucosal injury in 5 cases and unsatisfactory closure of the mucosal incision in 1 case. Upper gastrointestinal contrast radiography in all patients showed smooth passage of the contrast agent through the pylorus on postoperative day 3. The growth curves of the patients reached normal levels 3 months after the procedure. No recurrent clinical symptoms occurred in any patient during the median follow-up period of 25.5 (14-36) months. DISCUSSION:G-POEM is feasible, safe, and effective for infants with CHPS, with satisfactory clinical responses over a short-term follow-up. Further multicenter studies should be performed to compare the long-term outcomes of this minimally invasive technique with open or laparoscopic pyloromyotomy.

Applications of gastric peroral endoscopic myotomy in the treatment of upper gastrointestinal tract disease

“…Thus, G-POME is a technically feasible, safe, and successful procedure for treating CHPS, but the data available for evaluating the safety and efficacy of G-POME in infants with CHPS are quite limited. Zhang et al [ 73 ] analyzed 21 patients with CHPS treated with G-POME. All patients successfully underwent G-POME, and on the third day after surgery, oral meglumine diatrizoate was used for upper gastrointestinal radiography, with the contrast agent smoothly passing through the pylorus.…”

“…Another nasal gastric tube is placed in the other nostril, with the distal end located in the stomach, and is connected to an external drainage device to fully discharge gastric juice. If there is no leakage of contrast agent during the 3-day follow-up, the mucosal incision is allowed to recover, and oral enteral nutrition, breast milk, or high-energy milk powder is provided[ 73 ].…”

Exploring GI Diseases Across the Lifespan

“…Hypertrophic pyloric stenosis in infants is a major challenge that usually requires surgical intervention. A randomized control trial studied the utility of endoscopic POEMs for pyloric stenosis, with positive results (12). On the other extreme, 1 article found a substantial overlap of dementia with hepatic encephalopathy in Veterans with cirrhosis, which was much higher than the baseline prevalence across the general population (26).…”

“…In addition to medical care, the extremes of age also bring cost and healthcare delivery concerns, which several of our published articles focus upon (5,10,11). Finally, GI conditions unique to extremes of age need further ongoing research (12–15). We hope that this special issue will serve as a call to action to better understand the unique care of individuals in the extremes of age with GI disorders.…”

Gastric Peroral Endoscopic Pyloromyotomy for Infants With Congenital Hypertrophic Pyloric Stenosis: Ready for Prime Time?

“…In this issue of the Journal, Zhang et al (4) describe the first case series of pediatric patients undergoing G-POEM for congenital hypertrophic pyloric stenosis, building on the first case report of G-POEM in pediatrics by Kozlov et al (5) in 2019 in a 1-month-old infant. Twenty-one patients underwent successful G-POEM based on postoperative contrast radiography demonstrating normal passage across the pylorus and growth parameter improvements at the 1- and 3-month follow-ups.…”