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

Abstract

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.

The efficacy of newly proposed gastric open peroral endoscopic myotomy (GO-POEM) in preventing post-endoscopic submucosal dissection stenosis: A comparison with non-GO-POEM group

“…Temporary stent insertion has also been attempted for post-ESD stenosis management, but stent migration remains challenging. [20] GO-POEM was specifically designed to prevent stenotic symptoms and was introduced by Lee et al [14] as a novel technique for preventing stenosis post-ESD. The safety and efficacy of GO-POEM were demonstrated in a case study involving 10 patients.…”

“…GO-POEM was specifically designed to prevent stenotic symptoms and was introduced by Lee et al [ 14 ] as a novel technique for preventing stenosis post-ESD. The safety and efficacy of GO-POEM were demonstrated in a case study involving 10 patients.…”

“…[6] A recent study introduced a novel technique called gastric open peroral endoscopic myotomy (GO-POEM), which was safe and effective for preventing post-ESD stenosis. [14] Therefore, this study focused on comparing the effectiveness of GO-POEM with that of non-GO-POEM in preventing post-ESD stenosis in patients who had undergone extensive gastric ESD. Medicine…”

Comparison of prognostic outcomes between endoscopic submucosal dissection and surgical treatment for early gastric cancer: a retrospective cohort study

“…Several studies have investigated the efficacy and safety of ESD compared to surgical resection in the treatment of EGC. However, most of these studies have focused on short-term outcomes, and there is still limited data on the long-term outcomes of ESD compared to surgical resection, particularly in terms of recurrence rates and overall survival [ 7 , 8 ].…”