Role of gastric per-oral endoscopic myotomy (G-POEM) in post-lung transplant patients: a multicenter experience

Abstract

Background and study aims Gastroparesis post-lung transplant (LTx) can lead to increased risk of gastroesophageal reflux (GER) and accelerated graft dysfunction. We aimed to evaluate the efficacy and safety of gastric per-oral endoscopic myotomy (G-POEM), a promising tool in patients with refractory gastroparesis, for managing refractory gastroparesis and GER in post-LTx patients. Patents and methods This was a multicenter retrospective study on post-LTx patients who underwent G-POEM for management of gastroparesis and GER that were refractory to standard medical therapy. The primary outcome was clinical success post-G-POEM. Secondary outcomes included the rate of post-G-POEM objective esophageal pH exam normalization, rate of gastric emptying scintigraphy (GES) normalization, technical success, and adverse events. Results A total of 20 patients (mean age 54.7 ± 14.1 years, Female 50 %) underwent G-POEM at a median time of 13 months (interquartile range 6.5–13.5) post-LTx. All G-POEM procedures were technically successful. Clinical success was achieved in 17 (85 %) patients during a median follow-up time of 8.9 (IQR: 3–17) months post-G-POEM. Overall GCSI and two of its subscales (bloating and postprandial fullness/early satiety) improved significantly following G-POEM. Two patients (10 %) developed post-procedural AEs (delayed bleeding 1, pyloric stenosis 1, both moderate in severity). Post-G-POEM GES improvement was achieved in 12 of 16 patients (75 %). All 20 patients were on proton pump inhibitors pre-G-POEM, as opposed to five post-G-POEM. Post-G-POEM PH study normalization was noted in nine of 10 patients (90 %) who underwent both pre- and post-G-poem pH testing. Conclusions G-POEM is a promising noninvasive therapeutic tool for management of refractory gastroparesis and GER post-LTx.

Role of gastric peroral endoscopic myotomy (GPOEM) in chronic gastroparesis management after pancreas transplantation

“…There no other reports of G-POEM in post PT population in the literature, making it difficult to assess the incidence of adverse events related to the procedure, but the rate of 14% (one in seven) in our cohort does seem to compare to the rate in the post lung transplant population according to a retrospective multicenter trial. 50 We anticipate that the rate of complications will decrease as both our population and experience level continues to increase.…”

“…The first G-POEM in the post pancreatic transplant population was also performed in 2018 (Figure 1). In the literature, the use of G-POEM in the post-transplant population is most prevalent in lung transplant recipients 49,50 with no reported studies in patients status post pancreas transplant. In our single institution study, all patients were found to have some benefit after G-POEM.…”

Gastric Electrical Stimulation is an Effective Treatment Modality for Symptoms of GERD in Patients With Gastroparesis and VACTERL Association

“…18,19 Some small studies have shown that G-POEM in gastroparesis improves pH testing. 20 Ishak et al, evaluated 6 patients with gastroparesis and refractory reflux that underwent Dor fundoplication, pyloroplasty, and GES, who all showed significant improvement in heartburn and regurgitation scores after the procedure. 16…”

“…18,19 Some small studies have shown that G-POEM in gastroparesis improves pH testing. 20 Ishak et al, evaluated 6 patients with gastroparesis and refractory reflux that underwent Dor fundoplication, pyloroplasty, and GES, who all showed significant improvement in heartburn and regurgitation scores after the procedure. 16 Our patients experienced significant improvement in both classic gastroparesis symptoms as well as heartburn and reflux symptoms after the placement of temporary and subsequent permanent gastric stimulators.…”

Refractory Gastroesophageal Reflux Disease: Diagnosis and Management

“…A recent multicenter retrospective study of 20 lung transplant patients with concomitant GERD and gastroparesis demonstrated normalization of pH testing in 90% with improvement in gastric emptying and ability to wean off PPI therapy in 75%. 131 …”